scholarly journals Echocardiography Detection of High-Risk Patent Foramen Ovale Morphology

2021 ◽  
Vol 42 (3) ◽  
Author(s):  
Amiliana M Soesanto
Keyword(s):  
High Risk ◽  
Patent Foramen Ovale ◽  
Observational Studies ◽  
Technical Information ◽  
Paradoxical Embolism ◽  
Foramen Ovale

Patent Foramen Ovale occurs in 25% of the general population1. Several studies suggested that paradoxical embolism through a patent foramen ovale (PFO) correlate with cryptogenic strokes (CS). Many epidemiological and clinical observational studies, showed the association between CS and the presence of PFO.  There is still a controversy whether PFO should be closed. The information about PFO morphology might be useful for the management of PFO. This article is discussing a technical information about how echocardiography detects PFO and identifies high risk morphologies for the occurrence of PFO related -stroke.

scholarly journals Low-Angle Patent Foramen Ovale (PFO): High-Risk PFO Morphology Associated with Paradoxical Embolism

CASE ◽  
2021 ◽  
Author(s):  
Rie Nakayama ◽  
Yoichi Takaya ◽  
Teiji Akagi ◽  
Takashi Miki ◽  
Koji Nakagawa ◽  
...  
Keyword(s):  
High Risk ◽  
Patent Foramen Ovale ◽  
Paradoxical Embolism ◽  
Foramen Ovale

Abstract 33: PFO in Cryptogenic Stroke: An Analysis of “High Risk” Features on Transesophageal Echocardiography in the Risk of Paradoxical Embolism Database

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Benjamin Wessler ◽  
David E Thaler ◽  
Marco R Di Tullio ◽  
Robin Ruthazer ◽  
Christian Weimar ◽  
...  
Keyword(s):  
High Risk ◽  
Cohort Studies ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Imaging Techniques ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Attributable Fraction ◽  
Foramen Ovale ◽  
Additional Imaging

Introduction: A patent foramen ovale (PFO) discovered in the setting of a cryptogenic stroke (CS) may be stroke-related or incidental. We have developed a score to stratify CS patients according to the probability that the event is attributable to a PFO (the Risk of Paradoxical Embolism (RoPE) Score), based on easily obtainable clinical and neuroradiological (but not transesophageal echocardiographic (TEE) variables. In this study, we examined whether putative “high risk” TEE features - shunt size, presence of a hypermobile septum, and presence of a right-to-left shunt at rest - vary across RoPE Score strata. Methods and Results: The RoPE Study combined existing cohort studies to create a pooled database of patients with CS and PFO. We dichotomized patients into groups and examined whether putative high risk TEE features are seen more frequently in those with “probable stroke-related” PFOs (RoPE Score of >6, estimated PFO attributable fraction 72-99%, n=637) than in those with lower RoPE Scores (<6, PFO attributable fraction 0-71%, n=657). None of the TEE features differed between the groups (large physiologic size, p=0.53; hypermobile septum, p=0.44; shunt at rest, p=0.11). Extensive additional exploratory analyses did not reveal any consistent associations between different RoPE Score strata and presumptive high risk echocardiographic features. Conclusion: We found no evidence that proposed TEE markers for “high risk” PFOs correlate with the estimated likelihood that a PFO is related to an index CS. Additional imaging tools or better standardization of imaging techniques are needed to determine whether specific anatomic features are associated with whether a discovered PFO is likely to be related to CS.

Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

2020 ◽  
Vol 18 (2) ◽  
pp. 135-150
Author(s):  
Harsha S. Nagarajarao ◽  
Chandra P. Ojha ◽  
Archana Kedar ◽  
Debabrata Mukherjee
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Narrow Channel ◽  
Paradoxical Embolism ◽  
Current Evidence ◽  
Foramen Ovale ◽  
The Right ◽  
The Relationship ◽  
Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

Paradoxical embolism through patent foramen ovale as a cause of myocardial infarction

2021 ◽  
Author(s):  
Naim Mridha ◽  
Eloise Ward ◽  
Samual Hayman ◽  
Arun Dahiya ◽  
Sandhir Prasad
Keyword(s):  
Myocardial Infarction ◽  
Patent Foramen Ovale ◽  
Paradoxical Embolism ◽  
Foramen Ovale

scholarly journals Utility of transcranial color flow imaging for detecting high risk morphology of patent foramen ovale in patients with cerebral infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Chino ◽  
Y Mochizuki ◽  
E Toyosaki ◽  
M Ota ◽  
K Mizuma ◽  
...  
Keyword(s):  
High Risk ◽  
Patent Foramen Ovale ◽  
Cerebral Embolism ◽  
Flow Imaging ◽  
Foramen Ovale ◽  
Color Flow ◽  
Color Flow Imaging ◽  
Bubble Test ◽  
Micro Bubble ◽  
Group B

Abstract Background Micro-bubble test by using transcranial color flow imaging (TCCFI) is important as a screening evaluation for diagnosis of paradoxical cerebral embolism which requires the proof of right to left shunt at atrial septum. In addition, high risk features of patent foramen ovale (PFO) that may allow thrombus to easily pass through the PFO itself were previously reported. However, little is known about the association between the degrees on micro-bubble test by TCCFI and the features of high risk PFO. Purpose Our aim is to clarify the relationship between the degree of micro-bubble test in TCCFI and the morphology of PFO from transesophageal echocardiography (TEE). Methods Seventy-seven patients in whom cardiogenic embolism was strongly suspected by neurologists in Showa University from April to December in 2019 were retrospectively studied. 55 patients underwent both TCCFI and TEE with sufficient Valsalva stress. TCCFI grade of micro-bubble test was classified into 3 groups (A: none, B: small, and C: massive), in which signified “none” is no sign of micro-embolic signals (MES) within 30 seconds, “small” is 1 or more MES, and “massive” is so much MES look like a curtain (Figure). Evaluated high risk characteristics of PFO for cerebral embolism as previously reported were as follows; (1) tunnel height, (2) tunnel length, (3) total excursion distance into right and left atrium, (4) existence of Eustachian valve or Chiari network, (6) angle of PFO from inferior vena cava (7) large shunt (20 or more micro-bubbles). Results Of all TCCFI-positive patients (n=32; Group B=19, Group C=13) with cerebral embolism, PFOs were detected in 23 patients in TEE. Therefore, the sensitivity and specificity of TCCFI to PFO were 87% and 63% (AUC=0.75, p&lt;0.001, respectively). Interestingly, all 13 patients (Group C) had manifest PFOs. Moreover, group C include 2 patients with platypnea orthodeoxia syndrome in which hypoxia in the sitting position becomes apparent. Among PFO-positive patients, tunnel height, length, total excursion distance into right and left atrium, and large shunt in TEE were significantly larger in Group C than Group B (p&lt;0.05). Conclusions Micro-bubble test by using TCCFI may have screening advantages in predicting paradoxical cerebral embolism, high-risk morphology of PFO, and platypnea orthodeoxia syndrome. Figure 1 Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document