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https://www.readbyqxmd.com/read/28902595/patent-foramen-ovale-after-cryptogenic-stroke-assessing-the-evidence-for-closure
#1
Andrew Farb, Nicole G Ibrahim, Bram D Zuckerman
The Amplatzer PFO Occluder was approved by the Food and Drug Administration (FDA) on October 28, 2016. The device is indicated for percutaneous transcatheter closure of a patent foramen ovale to reduce the risk of recurrent ischemic stroke in patients who’ve had a cryptogenic stroke that a..
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902593/patent-foramen-ovale-closure-or-anticoagulation-vs-antiplatelets-after-stroke
#2
Jean-Louis Mas, Geneviève Derumeaux, Benoît Guillon, Evelyne Massardier, Hassan Hosseini, Laura Mechtouff, Caroline Arquizan, Yannick Béjot, Fabrice Vuillier, Olivier Detante, Céline Guidoux, Sandrine Canaple, Claudia Vaduva, Nelly Dequatre-Ponchelle, Igor Sibon, Pierre Garnier, Anna Ferrier, Serge Timsit, Emmanuelle Robinet-Borgomano, Denis Sablot, Jean-Christophe Lacour, Mathieu Zuber, Pascal Favrole, Jean-François Pinel, Marion Apoil, Peggy Reiner, Catherine Lefebvre, Patrice Guérin, Christophe Piot, Roland Rossi, Jean-Luc Dubois-Randé, Jean-Christophe Eicher, Nicolas Meneveau, Jean-René Lusson, Bernard Bertrand, Jean-Marc Schleich, François Godart, Jean-Benoit Thambo, Laurent Leborgne, Patrik Michel, Luc Pierard, Guillaume Turc, Martine Barthelet, Anaïs Charles-Nelson, Christian Weimar, Thierry Moulin, Jean-Michel Juliard, Gilles Chatellier
Background Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy. Methods In a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1)...
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902592/tipping-point-for-patent-foramen-ovale-closure
#3
EDITORIAL
Allan H Ropper
New England Journal of Medicine, Volume 377, Issue 11, Page 1093-1095, September 2017.
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902590/long-term-outcomes-of-patent-foramen-ovale-closure-or-medical-therapy-after-stroke
#4
Jeffrey L Saver, John D Carroll, David E Thaler, Richard W Smalling, Lee A MacDonald, David S Marks, David L Tirschwell
Background Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown. Methods In a multicenter, randomized, open-label trial, with blinded adjudication of end-point events, we randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group)...
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902580/patent-foramen-ovale-closure-or-antiplatelet-therapy-for-cryptogenic-stroke
#5
Lars Søndergaard, Scott E Kasner, John F Rhodes, Grethe Andersen, Helle K Iversen, Jens E Nielsen-Kudsk, Magnus Settergren, Christina Sjöstrand, Risto O Roine, David Hildick-Smith, J David Spence, Lars Thomassen
Background The efficacy of closure of a patent foramen ovale (PFO) in the prevention of recurrent stroke after cryptogenic stroke is uncertain. We investigated the effect of PFO closure combined with antiplatelet therapy versus antiplatelet therapy alone on the risks of recurrent stroke and new brain infarctions. Methods In this multinational trial involving patients with a PFO who had had a cryptogenic stroke, we randomly assigned patients, in a 2:1 ratio, to undergo PFO closure plus antiplatelet therapy (PFO closure group) or to receive antiplatelet therapy alone (antiplatelet-only group)...
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28886847/transcatheter-closure-of-patent-foramen-ovale
#6
EDITORIAL
Matthew J Price
No abstract text is available yet for this article.
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886846/transcatheter-closure-of-patent-foramen-ovale-devices-and-technique
#7
REVIEW
Matthew J Price
Transcatheter closure of a patent foramen ovale (PFO) reduces the risk of recurrent cryptogenic stroke compared with medical therapy. PFO closure is a prophylactic procedure, and will not provide the patient with symptomatic improvement, except in cases of hypoxemia due to right-to-left shunt or possibly migraine headaches. Therefore, appropriate patient selection is critical, and procedural safety is paramount. Herein, we review key characteristics of the devices currently available for transcatheter PFO closure within the United States, and highlight key technical aspects of the PFO closure procedure that will maximize procedural success...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886845/patent-foramen-ovale-closure-for-hypoxemia
#8
REVIEW
Jonathan M Tobis, Deepika Narasimha, Islam Abudayyeh
A patent foramen ovale (PFO) is a common anatomic finding in 20% of the normal population. Significant hypoxemia can occur in circumstances in which hemodynamic or anatomic changes predispose to increased right-to-left intra-atrial shunting. The subsequent hypoxemia produces substantial dyspnea that may affect the patient's quality of life, independent of underlying pulmonary disease. Profound hypoxemia caused by right-to-left shunt across the interatrial septum usually responds to percutaneous PFO closure...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886844/patent-foramen-ovale-and-migraine-headache
#9
REVIEW
David Hildick-Smith, Timothy M Williams
Migraine headache is a common and debilitating disease that has a demonstrable association with the presence of patent foramen ovale (PFO) in multiple case series. Closure of PFO has been performed to try to treat migraine with aura, with variable results. Although early trials suggested benefit to PFO closure, these were of poor quality, and subsequent randomized trials have failed to yield positive results. This article discusses the evidence of an association with PFO and migraine headache, and the trials that have so far been performed to assess the benefits of closure...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886843/current-dataset-for-patent-foramen-ovale-closure-in-cryptogenic-stroke-randomized-clinical-trials-and-observational-studies
#10
REVIEW
Olufunso W Odunukan, Matthew J Price
Approximately one-third of all strokes have no apparent cause. A patent foramen ovale (PFO) is present in as many as 60% of these patients with cryptogenic strokes, which is significantly more frequent than that of the general population. The presumed biologic mechanisms of ischemic stroke in the setting of a PFO are paradoxic embolism from the peripheral venous system through this interatrial shunt or embolism from in situ thrombosis. In this review, the authors summarize and critically assess the contemporary studies evaluating the efficacy and safety of PFO closure for prevention of recurrent cryptogenic strokes...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886842/imaging-assessment-of-the-interatrial-septum-for-transcatheter-atrial-septal-defect-and-patent-foramen-ovale-closure
#11
REVIEW
Mary Z Bechis, David S Rubenson, Matthew J Price
Transcatheter closure of atrial septal defects and patent foramen ovale has become increasingly common with advances in device and imaging technology. The percutaneous approach is now the preferred method of closure when anatomically suitable. Two-dimensional and 3-dimensional echocardiography determines anatomic suitability by characterizing the interatrial defect and its surrounding structures, and is critical for intraprocedural guidance and postprocedure follow-up. This article provides an overview of interatrial anatomy as it pertains to interventional considerations and discusses the transthoracic, transesophageal, and intracardiac echocardiographic modalities used for periprocedural and intraprocedural imaging of the interatrial septum...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886841/identification-and-quantification-of-patent-foramen-ovale-mediated-shunts-echocardiography-and-transcranial-doppler
#12
REVIEW
Ahmed N Mahmoud, Islam Y Elgendy, Nayan Agarwal, Jonathan M Tobis, Mohammad Khalid Mojadidi
Once deemed benign, patent foramen ovale (PFO)-mediated right-to-left shunting has now been linked to stroke, migraine, and hypoxemia. Contrast transesophageal echocardiography is considered the standard technique for identifying a PFO, allowing visualization of the atrial septal anatomy and differentiation from non-PFO right-to-left shunts. Transthoracic echocardiography is the most common method for PFO imaging, being cost-effective, but has the lowest sensitivity. Transcranial Doppler is highly sensitive but is unable to differentiate cardiac from pulmonary shunts; it is the best method to quantitate shunt severity, being more sensitive than transthoracic or transesophageal echocardiography so is our preferred screening method for PFO...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886840/cryptogenic-stroke-and-patent-foramen-ovale-risk-assessment
#13
REVIEW
Emiliya Melkumova, David E Thaler
Stroke is a devastating condition. It is the fifth leading cause of death in the United States, and a leading cause of serious long-term disability. Stroke occurs at any age. Younger patients tend to have strokes of undetermined cause, termed cryptogenic. Herein, the authors describe the classification of stroke cause; the risk of recurrent cryptogenic stroke with patent foramen ovale (PFO); a risk assessment model to stratify incidental versus a pathogenic PFO in patients presenting with stroke; and patient selection for device occluder therapy in the context of the long-term follow-up of the RESPECT randomized clinical trial...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28884743/three-dimensional-analysis-of-the-physiological-foramen-geometry-of-maxillary-and-mandibular-molars-by-means-of-micro-ct
#14
Thomas Gerhard Wolf, Frank Paqué, Michael Sven Patyna, Brita Willershausen, Benjamín Briseño-Marroquín
The aim of this study was to investigate the physiological foramen diameter, shape and distance between physiological and anatomical apex of maxillary and mandibular first and second molars. Accurate knowledge of the physiological foramina morphology; thus, inherent mechanical shaping technical hindrances, is decisive when taking the corresponding root canal final preparation decision. The morphological dimensions of a total of 1727 physiological foramina were investigated by means of micro-computed tomography...
September 8, 2017: International Journal of Oral Science
https://www.readbyqxmd.com/read/28880140/-diving-accident-induced-arterial-gas-embolism
#15
P D Nijk, T P van Rees Vellinga, J M van Lieshout, M I Gaakeer
BACKGROUND: During scuba diving, nitrogen dissolves into the body tissues due to elevated pressure under water. During a sudden drop in pressure due to a rapid return to the water surface, arterial gas embolism can arise from pulmonary barotrauma. In a later phase, nitrogen bubbles can also arise in the venous circulation (decompression sickness). Arterial bubbles can incur vascular damage, obstruction, hypoxia and infarction. CASE DESCRIPTION: A 53-year-old healthy sport diver presented at the emergency department in a hypovolemic shock with progressive paresis of all the extremities...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28872450/the-association-between-aortic-regurgitation-and-undetermined-embolic-infarction-with-aortic-complex-plaque
#16
Dae-Won Kim, Jung Sun Cho, Jae Yeong Cho, Kye Hun Kim, Byung Joo Sun, Jae-Hyeong Park
Background Retrograde embolism from the descending thoracic aorta is one possible cause of undetermined ischemic stroke. Significant aortic regurgitation can increase the amount of reversed flow in the thoracic aorta and thus is associated with an increased incidence of stroke. Aims This study aimed to examine the association between significant aortic regurgitation and undetermined embolic infarction with aortic complex plaques. Methods This study included 380 patients with undetermined embolic stroke who did not have abnormal flow such as atrial septal defect, patent foramen ovale determined by agitated saline bubble test, intracardiac thrombi on transesophageal echocardiography, atrial fibrillation, or small vessel stroke, cerebral artery, and carotid stenosis on the brain magnetic resonance imaging...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28868599/diving-with-pre-existing-medical-conditions
#17
John Lippmann, David McD Taylor, Christopher Stevenson, Jo Williams, Simon J Mitchell
INTRODUCTION: This is the second report based on a survey of Divers Alert Network Asia-Pacific (DAN AP) members who dive with cardiovascular and respiratory conditions and diabetes. It examines the medical management of the divers' conditions, any diving modifications used to mitigate the risk and outcomes. METHODOLOGY: An online cross-sectional survey was sent to 833 divers who had declared a targeted medical condition when applying for DAN AP membership between July 2009 and August 2013...
September 2017: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/28868103/ischemic-stroke-in-a-patient-with-quadricuspid-aortic-valve-and-patent-foramen-ovale
#18
Michael Spartalis, Eleni Tzatzaki, Eleftherios Spartalis, Christos Damaskos, Demetrios Moris, Dimitrios Tsiapras, Vassilis Voudris
Quadricuspid aortic valve (QAV) is a rare congenital aortic valve abnormality. It is less common as compared to bicuspid or unicuspid aortic valve abnormality. QAV causes aortic regurgitation usually in the fifth to sixth decade of life. We present a rare case of a female patient with cryptogenic stroke due to a QAV and a patent foramen ovale (PFO). The patient underwent transcatheter closure of PFO, as there was no clear indication for surgery for her valve. Surgical removal remains the method of choice for the treatment of the QAV before left ventricular decompensation occurs...
August 2017: Cardiology Research
https://www.readbyqxmd.com/read/28867262/persistent-hypoxemia-after-acute-myocardial-infarction-an-unexpected-culprit
#19
António Tralhão, Pedro Freitas, Gustavo Rodrigues, Hugo Café, António Miguel Ferreira, Henrique Mesquita Gabriel, Luís Bruges, Carlos Aguiar, Jorge Ferreira
Hypoxemia after myocardial infarction (MI) is usually explained by common culprits, including congestive heart failure, pre-existing lung disease, and pulmonary infection. We report a case of a 60-year-old woman who experienced severe persistent hypoxemia caused by a patent foramen ovale in the setting of anterior MI complicated by a contained left ventricular rupture.
July 29, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28863111/the-endoscopic-prelacrimal-recess-approach-to-the-pterygopalatine-fossa-and-infratemporal-fossa
#20
Li Gao, Lei Zhou, Zhengshou Dai, Xinsheng Huang
PURPOSE: The authors studied the anatomic importance of the endoscopic prelacrimal recess approach (PLRA) to the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). METHODS: Ten adult heads (20 sides) from cadavers fixed in formalin were dissected using the PLRA. Anatomic dissections were detailed and several crucial landmarks measured. RESULTS: Identification of the infraorbital neurovascular bundle is the crucial step for the detection of other branches of the maxillary artery...
September 2017: Journal of Craniofacial Surgery
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