5,901 results on '"patent foramen ovale"'
Search Results
2. Researchers Submit Patent Application, "Identification Of Guidewire Position During A Procedure", for Approval (USPTO 20240245466).
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MACHINE learning ,LEFT heart ventricle ,PATENT foramen ovale ,TECHNOLOGICAL innovations ,IMAGE sensors - Abstract
Libra Science Ltd. has submitted a patent application for a computer-based method and system that monitors the position of a guidewire during medical procedures. The method involves analyzing baseline images to determine the guidewire's movement during heartbeats and breathing cycles, and then monitoring subsequent images for any deviations from this baseline movement. Techniques such as image analysis, polynomial fitting, and machine learning can be used to track the guidewire's movement. The system aims to enhance the accuracy and safety of medical procedures involving guidewires. The patent application provides further information and claims for this invention. [Extracted from the article]
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- 2024
3. "Bioabsorbable Occlusion System" in Patent Application Approval Process (USPTO 20240215967).
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PATENT applications ,BIOABSORBABLE implants ,VENTRICULAR septal defects ,PATENT foramen ovale ,ATRIAL septal defects - Abstract
A patent application has been filed for a bioabsorbable occlusion system for treating openings or defects in the heart. The system includes an occlusion implant with two anchors and a connector element that draws the anchors together. The entire implant is bioabsorbable and can be inserted into the heart in a collapsed state before expanding to occlude the opening. The method involves using a guide catheter and a delivery device to position the implant and secure it in place. The system has potential applications for various heart defects and can prevent the need for permanent implants. [Extracted from the article]
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- 2024
4. Clinical implications and procedural complications in patients with patent foramen ovale concomitant with atrial septal aneurysm.
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PATENT foramen ovale ,ANEURYSMS ,HEART septum ,ATRIAL septum ,RIGHT heart atrium - Abstract
This article discusses the clinical implications and procedural complications in patients with patent foramen ovale (PFO) concomitant with atrial septal aneurysm (ASA). ASA is defined as the excursion of the atrial septum exceeding a certain measurement, and previous studies have shown that 20-40% of PFO cases are accompanied by ASA. The presence of ASA is associated with various conditions such as left atrial dysfunction, cryptogenic stroke, migraine, and arterial embolism, making the closure of PFO in patients with concomitant ASA necessary but challenging. The article reviews the clinical implications, complications, and provides practical guidance for the closure procedure of concomitant PFO and ASA. [Extracted from the article]
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- 2024
5. Patent Application Titled "Closure System, And Manufacturing Method Of Closure Device" Published Online (USPTO 20240197329).
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PATENT applications ,INTERNET publishing ,HEART septum ,ATRIAL septal defects ,PATENT foramen ovale ,PATENT ductus arteriosus - Abstract
The US Patent and Trademark Office has published a patent application for a closure system designed to close holes or ducts in heart tissue. The system, invented by Harutoshi UCHIDA, includes a catheter and a closure device consisting of a resin-containing extension part. The patent application also outlines a manufacturing method that involves using a learning model to design the closure device based on the shape and position of the hole or duct. The closure device may include additional features such as a heart rate sensor or a power generating element. This system aims to address issues associated with existing closure devices and provide an effective solution for closing various types of holes or ducts in the heart. [Extracted from the article]
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- 2024
6. Patent Issued for Characterization of cardiac shunts with bubbles (USPTO 11986342).
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CEREBROSPINAL fluid shunts ,PATENT foramen ovale ,PATENTS ,ATRIAL septal defects - Abstract
A patent has been issued to Agitated Solutions Inc. for the characterization of cardiac shunts with bubbles. The patent describes a method that involves directing bubbles into a patient's venous circulatory system and monitoring their presence on the left side of the heart using ultrasound imaging. The size of the bubbles varies in three ranges, and if bubbles are detected on the left side of the heart, treatment is initiated to minimize the risk of stroke. Treatment options include administering a blood thinner or surgically closing a shunt in the patient's heart. The patent provides detailed information on the method and its implementation. [Extracted from the article]
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- 2024
7. "Vascular Occlusion" in Patent Application Approval Process (USPTO 20240050096).
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PATENT applications ,PATENT foramen ovale ,ATRIAL septal defects - Abstract
A patent application by Terumo Corporation has been made available online for an occlusive system that utilizes embolic coils to treat various vascular disorders. The system includes different embodiments such as a containment bag, balloon, protective disk, protective mesh, and a sheet. The patent application also describes an occluder with inner and outer structures, as well as an expandable vascular plug with an outer layer of struts and an inner layer of mesh. The patent application provides detailed claims for the different components of the occlusive system. [Extracted from the article]
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- 2024
8. Submassive pulmonary embolism with a right heart thrombus
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Winnie Yan, Ali Hafiz, Ingrid Gunther, and Ronald Goldenberg
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medicine.medical_specialty ,Foramen Ovale, Patent ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Intensive care ,medicine ,Humans ,Intravenous tissue plasminogen activator ,Thrombus ,Stroke ,business.industry ,Treatment options ,Thrombosis ,General Medicine ,Middle Aged ,medicine.disease ,Pulmonary embolism ,030228 respiratory system ,Tissue Plasminogen Activator ,Right heart ,Cardiology ,Patent foramen ovale ,Female ,business ,Pulmonary Embolism - Abstract
A 49-year-old woman presented to the hospital with shortness of breath 2 weeks after a left total hip replacement. She was found to have a submassive pulmonary embolism (PE), with her case complicated by the detection of a large mobile clot in transit extending through a patent foramen ovale between the right and left atria. The presence of this free-floating right heart thrombus (FFRHT) increases her risks of stroke and mortality, yet the optimal approach to her treatment was unclear. Ultimately, intravenous tissue plasminogen activator was administered with resolution of the clot. Treatment was complicated by haemodynamically insignificant bleeding at the site of recent surgery. Herein, we further discuss the implications and treatment options for patients with an FFRHT in the setting of an acute PE.
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- 2023
9. Intracardiac platypnea-orthodeoxia syndrome diagnosed by forward-bending and abdominal compression
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Satoshi Yoshikawa, Takeshi Ueda, and Ryo Kitamura
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medicine.medical_specialty ,Posture ,Foramen Ovale, Patent ,Sitting ,Intracardiac injection ,Internal medicine ,medicine.artery ,mental disorders ,medicine ,Humans ,Hypoxia ,Aged, 80 and over ,Aorta ,business.industry ,Central venous pressure ,General Medicine ,Syndrome ,medicine.disease ,medicine.anatomical_structure ,Dyspnea ,Ventricle ,cardiovascular system ,Patent foramen ovale ,Cardiology ,Female ,business ,Shunt (electrical) ,Venous return curve - Abstract
Intracardiac platypnea–orthodeoxia syndrome (POS) is a pathological condition that leads to a reduction in oxygenation in the sitting position. The detection rate of patent foramen ovale that causes POS increases with Valsalva manoeuvre and cough. We report the case of a 92-year-old woman with POS, which could not be diagnosed in the sitting position. The Valsalva manoeuvre could not be performed because of dementia, and POS was diagnosed on the forward-bending position and abdominal compression. It was assumed that forward-bending increases the right atrial pressure by compressing the right ventricle along with elongation of the aorta, and abdominal compression increases the shunt volume by increasing the venous return. If POS is suspected in patients with dementia which cannot be diagnosed in the sitting position, forward-bending and abdominal compression, instead of the Valsalva manoeuvre, might be useful.
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- 2023
10. Young stroke due to pulmonary arteriovenous malformation
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Myo T Lwin, Lindsay Smith, Nicolas Weir, and Gautam Sen
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0301 basic medicine ,medicine.medical_specialty ,Congenital pulmonary arteriovenous fistula ,Foramen Ovale, Patent ,Case Report ,030105 genetics & heredity ,Pulmonary Artery ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,In patient ,Pulmonary arteriovenous malformation ,Stroke ,business.industry ,Vascular malformation ,General Medicine ,medicine.disease ,Migraine with aura ,Pulmonary Veins ,Transcatheter occlusion ,Arteriovenous Fistula ,cardiovascular system ,Patent foramen ovale ,Cardiology ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Young patients presenting with cryptogenic stroke should be investigated for cardiac and extra-cardiac sources of emboli. We present a patient who was investigated for a cardiac source of emboli, following multiple ischaemic strokes and migraine with aura over a period of 17 years. The events were initially thought to be related to a patent foramen ovale (PFO) on bubble contrast echocardiography, however, due to an unusual flow pattern to the left heart, she underwent a CT angiogram to exclude intrapulmonary shunting. This confirmed the presence of a moderate sized congenital pulmonary arteriovenous fistula in the left lung. Transcatheter occlusion of the vascular malformation has resolution of her symptoms. Bubble contrast echocardiography is routinely used to diagnose a PFO in these cases, but extreme caution is required during the procedure to differentiate the pattern of flow seen in patients with a pulmonary arteriovenous malformation.
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- 2023
11. Premature closure of ductus arteriosus after a single dose of diclofenac during pregnancy
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Constança Santos, Joaquim Tiago, Patricia Vaz Silva, and Rui Castelo
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Male ,Neonatal intensive care unit ,Diclofenac ,Pregnancy Trimester, Third ,Case Report ,Propranolol ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Ventricular hypertrophy ,Pregnancy ,030225 pediatrics ,Ductus arteriosus ,medicine ,Humans ,Pharmacology (medical) ,cardiovascular diseases ,Ductus Arteriosus, Patent ,Fetus ,Premature Closure ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Infant, Newborn ,Ductus Arteriosus ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Anesthesia ,Patent foramen ovale ,Female ,business ,medicine.drug - Abstract
A male term neonate was admitted to the neonatal intensive care unit in the first hours of life with central cyanosis. Echocardiogram showed severe biventricular hypertrophy, markedly right-sided, tricuspid regurgitation, a patent foramen ovale and a closed ductus arteriosus (CDA). The mother recalled being treated with a single dose of intravenous diclofenac for low back pain 2 weeks earlier. The newborn was started on propranolol with symptomatic improvement and was discharged on day 10. At 1-month follow-up, he showed complete resolution of ventricular hypertrophy and suspended propranolol. In the literature, of the 22 cases of CDA after intrauterine exposure to diclofenac, 11 resolved in utero, 3 required ventilatory and inotropic support and 1 evolved to persistent pulmonary hypertension. In this case, a thorough anamnesis was key to identify the probable cause of an otherwise unexplained transient ventricular hypertrophy. This case also alerts to the fetal risks of non-steroidal anti-inflammatory drugs during the third trimester, requiring close monitoring.
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- 2022
12. Cerebral paradoxical embolisation in a patient with cystic fibrosis with patent foramen ovale: a comparative review of literature
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Adrian W. Messerli, Taha Ahmed, Michael I. Anstead, and Samra Haroon Lodhi
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medicine.medical_specialty ,Percutaneous ,Cystic Fibrosis ,Foramen Ovale, Patent ,Context (language use) ,Case Report ,030204 cardiovascular system & hematology ,Intracardiac injection ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Thrombectomy ,business.industry ,Brain ,General Medicine ,Middle Aged ,medicine.disease ,Venous thrombosis ,Hemiparesis ,Expressive aphasia ,Patent foramen ovale ,Female ,Radiology ,medicine.symptom ,business ,Embolism, Paradoxical - Abstract
A 52-year-old woman with cystic fibrosis presented to the emergency department with expressive aphasia and right-sided hemiparesis. CT scan of the brain revealed a left middle cerebral artery territory infarct. A diagnosis of cerebral paradoxical embolisation associated with patent foramen ovale and a history of deep venous thrombosis was made. The patient underwent endovascular thrombectomy and percutaneous closure of patent foramen ovale. Current literature, including five published case reports, pertaining to the subject is discussed. The unique aspects of the case are highlighted, including the particular risk of cerebral paradoxical embolisation in patients with cystic fibrosis. The result of this case report, in context to previously reported literature, suggests that clinicians should be aware of paradoxical embolisation in patients with cystic fibrosis via an intracardiac shunt, particularly with implanted vascular access devices and a history of deep venous thrombosis.
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- 2023
13. Major clinical impact of patent foramen ovale after HeartMate3 implantation: periprocedural diagnosis and its pitfalls
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C Strong, Carlos Aguiar, Bruno da Costa Rocha, and Catarina Brízido
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medicine.medical_specialty ,Percutaneous ,Hemodynamics ,Foramen Ovale, Patent ,Case Report ,030204 cardiovascular system & hematology ,Intracardiac injection ,Hypoxemia ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Hypoxia ,business.industry ,General Medicine ,medicine.disease ,Shunt (medical) ,030228 respiratory system ,Cardiothoracic surgery ,Heart failure ,Cardiology ,Patent foramen ovale ,medicine.symptom ,business - Abstract
We report a clinically significant right-to-left intracardiac shunt through a patent foramen ovale, diagnosed during investigations for hypoxemia and left ventricular dilation on the late postoperative period of a HeartMate3 implantation. We discuss diagnostic pitfalls and haemodynamic influences in this scenario, as well as the possibility of successful percutaneous treatment.
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- 2023
14. Clinical and echocardiographic outcomes after percutaneous closure of patent foramen ovale: a single center experience
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Paolo Serafin, Davood Safari, Remo Albiero, Elia R. Rigamonti, Alberto Maria Lanzone, Amedeo Anselmi, Gianluca Lussardi, and Emiliano Boldi
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education.field_of_study ,medicine.medical_specialty ,Percutaneous ,business.industry ,Sedation ,Population ,medicine.disease ,Secondary procedure ,Surgery ,Single centre ,Migraine ,Patent foramen ovale ,medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,education ,business ,Shunt (electrical) - Abstract
BACKGROUND Patent Foramen Ovale (PFO) has a high estimated prevalence (25% of the general population) and has been implicated in the pathogenesis of cryptogenic stroke and transient ischemic attack (TIA), as well as in the pathogenesis of migraine headache. This study evaluated the effectiveness of percutaneous transcatheter PFO closure with Amplatzer devices, from a large single-center experience. METHODS from January 1998 to December 2014, 577 patients (243 males and 334 females, mean age 50 years, range 11-82 years) with documented PFO and history of at least one episode of cryptogenic stroke/TIA (n=356) or occasional finding of previous ischemic lesions on MRI (n=221) underwent percutaneous transcatheter closure of PFO using an Amplatzer™ Occluder. All the procedures were performed under general anesthesia or mild sedation, and were assisted by transesophageal or intracardiac echocardiography. RESULTS Procedural success was 100%. After a median follow-up period of 2.7 years with echocardiographic evaluations, the rate of recurrent adverse cerebral events was 0.4%. Two patients (0.4%) required a secondary procedure for significant residual shunt. Of 36 patients with minor residual shunt, 30 (83%) showed spontaneous shunt regression at follow-up. There was a consistent decrease after procedure in headache migraine, Platypnea-Orthodeoxia, fainting episodes, syncope, and Coenaesthesia Phenomena. CONCLUSIONS Transcatheter PFO closure is an effective and safe therapy for the prevention of thromboembolic events in the patients with cryptogenic stroke/TIA or an occasional finding of a positive cerebral MRI. Late follow-up shows device stability and clinical improvement in the majority of patients.
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- 2023
15. Localization of Infratentorial Lesion could Predict Patent Foramen Ovale as an Etiology in Embolic Stroke of Undetermined Source
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Kazuo Kitagawa, Eiko Higuchi, Kentaro Ishizuka, Takao Hoshino, and Sono Toi
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medicine.medical_specialty ,Foramen Ovale, Patent ,Lesion ,Risk Factors ,Internal Medicine ,medicine ,Humans ,Ischemic Stroke ,Embolic Stroke ,medicine.diagnostic_test ,business.industry ,Biochemistry (medical) ,Magnetic resonance imaging ,Odds ratio ,medicine.disease ,Confidence interval ,Embolic stroke ,Stroke ,Infarction ,Angiography ,Patent foramen ovale ,Etiology ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aim Embolic stroke of undetermined source (ESUS) is a clinical construct introduced to describe cryptogenic stroke cases with ambiguous diagnoses. Cardiac causes are recognized as a major cause of ESUS, Patent foramen ovale (PFO) being among them. We aimed to investigate the relationship between infarct patterns and PFO in patients with ESUS. Methods We evaluated 190 consecutive patients with ESUS registered in the Tokyo Women's Medical University Stroke Registry. Among them, 94 patients who underwent magnetic resonance imaging and angiography, as well as transthoracic and transesophageal echocardiography, were included in this study. The infarct patterns were classified according to location (infratentorial or non-infratentorial lesions), size (small or large infarcts), and number (single or multiple lesions). Results Prevalence of PFO was significantly higher in patients in the infratentorial than those in the non-infratentorial lesion group (40.7% versus 14.9%, respectively; P=0.007). However, neither lesion size nor number were associated with PFO. In multivariate logistic regression analysis, the presence of infratentorial lesions was independently associated with PFO in ESUS patients (odds ratio: 2.18; 95% confidence interval: 1.24-3.95; P<0.007). In 21 patients with PFO, large PFOs were more prevalent in the infratentorial than in the non-infratentorial lesion group. Conclusions Infratentorial lesions may be independently associated with PFO in patients with ESUS. The presence of infratentorial lesions could predict the presence of PFO in ESUS cases.
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- 2022
16. A systematic transoesophageal echocardiography study of suture-mediated percutaneous patent foramen ovale closure
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Francesco Melillo, Alessandro Beneduce, Ciro Vella, Filippo Russo, Luca A. Ferri, Barbara Bellini, Marco Ancona, Matteo Montorfano, Giacomo Ingallina, Francesco Ancona, Alaide Chieffo, Francesco Moroni, and Eustachio Agricola
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Cardiac Catheterization ,medicine.medical_specialty ,Percutaneous ,Sutures ,business.industry ,Short Report ,Closure (topology) ,Foramen Ovale, Patent ,medicine.disease ,Surgery ,Treatment Outcome ,Suture (anatomy) ,Patent foramen ovale ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Published
- 2022
17. Complete atrioventricular septal defect with absent or diminutive primum component: Incidence, anatomic characteristics, and outcomes
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Lester C. Permut, Michael H. Kwon, Muhammad K. Nuri, D. Michael McMullan, Amy H. Schultz, and Madonna Lee
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Reoperation ,Pulmonary and Respiratory Medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Transesophageal echocardiogram ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Operative report ,Humans ,cardiovascular diseases ,Atrioventricular Septal Defect ,Cardiac Surgical Procedures ,Atrium (heart) ,Retrospective Studies ,Atrioventricular valve ,medicine.diagnostic_test ,business.industry ,Heart Septal Defects ,Incidence ,Mitral Valve Insufficiency ,Recovery of Function ,medicine.disease ,Tricuspid Valve Insufficiency ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,cardiovascular system ,Patent foramen ovale ,Cardiology ,Surgery ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Repair of complete atrioventricular septal defect with absent or diminutive primum defect is challenging because of atrial septal malposition and abnormal anatomy of the left atrioventricular valve. We sought to define the incidence, anatomy, and surgical outcomes of this entity. Methods We identified all patients in our institutional database presenting for complete atrioventricular septal defect repair from 2006 to 2018. Operative reports and echocardiograms were reviewed to determine the presence and size of the primum defect, atrioventricular valve anatomy, degree of atrioventricular valve regurgitation, repair method, and complications, including reoperation for atrioventricular valve regurgitation. Functionally univentricular patients and those receiving repair at an outside institution were excluded. Results Of 183 patients with complete atrioventricular septal defect, absent/diminutive primum defect occurred in 16 patients (8.7%; 10 absent, 6 diminutive). Six patients (38%) had leftward malposition of the atrium septum on the common atrioventricular valve. The rate of reoperation for left atrioventricular valve regurgitation was 31% (3 early, 2 late), for which preoperative predictors included leftward malposition of the atrial septum onto the common atrioventricular valve (4/6 patients with malposition required reoperation, P = .036, Fisher exact test). One patient exhibiting this risk factor died. The overall rate of moderate or greater left atrioventricular valve regurgitation on the most recent postoperative echocardiogram was 13% (2/16 patients; median follow-up, 141 days; range, 3-2236 days). Conclusions Complete atrioventricular septal defect with absent or diminutive primum defect is a unique variant of complete atrioventricular septal defect for which the risk of reoperation for left atrioventricular valve regurgitation after complete repair is high and risk factors include leftward malposition of the atrial septum on the common atrioventricular valve.
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- 2022
18. Patent Application Titled "Occlusion Device And Method For Its Manufacture" Published Online (USPTO 20240016488).
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PATENT applications ,INTERNET publishing ,ATRIAL septal defects ,PATENT foramen ovale ,SHAPE memory effect - Abstract
A patent application has been published by the US Patent and Trademark Office for an occlusion device developed by inventors from Germany. The device is designed for non-surgical transvenous catheter intervention to occlude septal defects. The inventors address the limitations of current occlusion devices and propose a new design that lies flat against the septum, reduces material fatigue, and is cost-effective to manufacture. The patent application also includes a method for manufacturing the occlusion device using a braiding machine. The inventors claim that their device and manufacturing method offer advantages over existing occlusion systems, including reduced material fatigue and manufacturing costs. [Extracted from the article]
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- 2024
19. Patent Issued for Transseptal puncture apparatus and method for using the same (USPTO 11844913).
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NEEDLES & pins ,RIGHT heart atrium ,PATENTS ,VENA cava superior ,PATENT foramen ovale ,MEDICAL supplies - Abstract
A patent has been issued for a transseptal puncture apparatus and method. The patent, assigned to Boston Scientific Medical Device Limited, describes a device and technique for safely puncturing the atrial septum in the heart. The invention aims to reduce the risk of inadvertent puncture through tissue other than the septum, which can pose a significant risk to the patient. The device includes a flexible introducer and a blunt-ended cannula, which provide columnar support for a sharp-ended floppy guidewire to penetrate the septum. The method involves accessing the right atrium, tenting the septal wall, advancing the guidewire through the septum, and accessing the left atrium. This patent offers potential advancements in transseptal procedures, particularly for patent foramen ovale (PFO) closure. [Extracted from the article]
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- 2024
20. Screening and Risk Stratification Strategy Reduced Decompression Sickness Occurrence in Divers With Patent Foramen Ovale
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Tomáš Honěk, Martin Šrámek, Marek Brabec, Jakub Honěk, Josef Veselka, Jiří Fiedler, Aleš Tomek, Jaroslav Januška, Luděk Šefc, Martin Horváth, and Štěpán Novotný
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business.industry ,Incidence (epidemiology) ,Decompression illness ,medicine.disease ,Decompression sickness ,Catheter ,Paradoxical embolism ,Pfo closure ,Anesthesia ,Risk stratification ,Patent foramen ovale ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
Objectives This paper sought to evaluate the occurrence of decompression sickness (DCS) after the application of a patent foramen ovale (PFO) screening and risk stratification strategy. Background PFO is associated with an increased risk of DCS. Recently, transcatheter closure was reported to reduce DCS occurrence in divers with a high-grade shunt. However, to date, there are no data regarding the effectiveness of any PFO screening and risk stratification strategy for divers. Methods A total of 829 consecutive divers (35.4 ± 10.0 years, 81.5% men) were screened for PFO by means of transcranial color-coded sonography in the DIVE-PFO (Decompression Illness Prevention in Divers with a Patent Foramen Ovale) registry. Divers with a high-grade PFO were offered either catheter-based PFO closure (the closure group) or advised conservative diving (high grades). Divers with a low-grade shunt were advised conservative diving (low grades), whereas those with no PFO continued unrestricted diving (controls). A telephone follow-up was performed. To study the effect of the screening and risk stratification strategy, DCS occurrence before enrollment and during the follow-up was compared. Results Follow-up was available for 748 (90%) divers. Seven hundred and 2 divers continued diving and were included in the analysis (mean follow-up 6.5 ± 3.5 years). The DCS incidence decreased significantly in all groups, except the controls. During follow-up, there were no DCS events in the closure group; DCS incidence was similar to the controls in the low-grade group (HR: 3.965; 95% CI: 0.558-28.18; P = 0.169) but remained higher in the high-grade group (HR: 26.170; 95% CI: 5.797-118.16; P Conclusions The screening and risk stratification strategy using transcranial color-coded sonography was associated with a decrease in DCS occurrence in divers with PFO. Catheter-based PFO closure was associated with a DCS occurrence similar to the controls; the conservative strategy had a similar effect in the low-grade group, but in the high-grade group the DCS incidence remained higher than in all other groups.
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- 2022
21. Hypoxemia found after hospitalization with right hemiplegia due to cerebral infarction: platypnea-orthodeoxia syndrome in the older people
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Teppei Murata, Akiko Kanemaru, Kazumasa Harada, Keiko Hatano, Masatoshi Tachibana, and Joji Ishikawa
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medicine.medical_specialty ,Cerebral infarction ,business.industry ,medicine.medical_treatment ,Case Report ,medicine.disease ,Sitting ,Trunk ,Hypoxemia ,Internal medicine ,Recumbent Position ,Patent foramen ovale ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiac catheterization ,Oxygen saturation (medicine) - Abstract
An 89-year-old woman was admitted to our hospital for subacute onset of right upper and lower limb weakness and was diagnosed with acute cerebral infarction. During rehabilitation, close observation revealed that her oxygen saturation decreased in the sitting position and improved in the recumbent position without any subjective symptoms of dyspnea. Transthoracic and transesophageal echocardiography and cardiac catheterization revealed a large patent foramen ovale with an atrial septal aneurysm with right-to-left shunting through the defect, and she was diagnosed with platypnea-orthodeoxia syndrome. Her right hemiplegia caused the trunk to collapse, so the patient slumped when in sitting position, and the trunk tilted to the right forward, resulting in an increased right-to-left shunt. Her peripheral capillary oxygen saturation improved in the upright sitting position supported by therapists. This case suggests that right hemiplegia may exacerbate the symptoms of platypnea-orthodeoxia syndrome.
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- 2022
22. Early Results of Robotically Assisted Congenital Cardiac Surgery: Analysis of 242 Patients
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Burak Onan and İsmihan Selen Onan
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Adult ,Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Adolescent ,Septum secundum ,030204 cardiovascular system & hematology ,Atrial septal defects ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,law ,medicine ,Cardiopulmonary bypass ,Humans ,Robotic surgery ,Cardiac Surgical Procedures ,Child ,Retrospective Studies ,business.industry ,Middle Aged ,Primary interatrial foramen ,medicine.disease ,Cardiac surgery ,Surgery ,Treatment Outcome ,030228 respiratory system ,Patent foramen ovale ,Feasibility Studies ,Female ,Subvalvular Aortic Stenosis ,Cardiology and Cardiovascular Medicine ,business ,Colonography, Computed Tomographic ,Follow-Up Studies - Abstract
Background Robotic surgery is an alternative to traditional and minimally invasive cardiac procedures. The adaption of robotics in congenital cardiac surgery has remained limited, however. We analyzed the early outcomes of our single-center experience in robotically assisted congenital cardiac surgery. Methods From May 2013 to February 2020, 242 robotic operations were done for secundum atrial septal defects (74.7%), sinus venous atrial septal defects (16.1%), partial anomalous pulmonary venous connections (10.7%), widely patent foramen ovale (3.7%), ostium primum defects (2.5%), unroofed coronary sinus (1.2%), partial atrioventricular canal defects (2.5%), residual septal defects after failed percutaneous closure (1.2%), ventricular septal defect (0.4%), cor triatriatum sinister (0.4%), subvalvular aortic stenosis (0.4%), common atrium (0.4%), and double-chambered right ventricle (0.4%) using the da Vinci system. Results There was no mortality. Mean age was 30.9 ± 12.1 years, and 132 (54.5%) patients were female. Thirty (12.3%) patients were pediatric (median, 16 years; range, 12-17 years). Mean cardiopulmonary bypass and aortic clamping times were 89.5 ± 30.0 and 44.9 ± 22.3 minutes, respectively. We noted a steady decrease in operation times during the first year. Conversion to larger thoracic incisions was needed in 2 (0.8%) patients. The postoperative rates of stroke, cardiac events, pulmonary complications, and reexploration were 0.4%, 2.4%, 4.1%, and 0.8%, respectively. Mean hospital stay was 3.5 ± 1.1 days. Conclusions Robotic technology can be utilized to perform suitable congenital cardiac procedures safely and effectively. With acceptable complication rates, robotic surgery can be an alternative to traditional, minimally invasive, and endoscopic approaches in adolescent and adult patients.
- Published
- 2021
23. Prise en charge de l'AVC cryptogénique : où en sommes-nous ?
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P Aubry, N Camara, N Poulos, A Naoum-Nehme, B Maiga, A Alqudwa, F Hamidouche, and E Manchon
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medicine.medical_specialty ,business.industry ,Individualized treatment ,Atrial fibrillation ,medicine.disease ,Embolic stroke ,Cryptogenic stroke ,Internal medicine ,Ischemic stroke ,Patent foramen ovale ,medicine ,Cardiology ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Cryptogenic stroke is an old definition that designates an ischemic stroke with no identifiable cause. The term of the embolic stroke of undetermined source was then introduced to identify non-lacunar strokes in whom thromboembolism was the likely mechanism. This subgroup of cryptogenic strokes remains heterogeneous with many potential and possibly associated embolic causes. Covert atrial fibrillation is probably less often involved than initially expected, in contrast to intracranial and extracranial atherosclerosis. The cardiologist should be involved in the search of underlying causes of ischemic stroke by helping the neurologist to identify the most likely diagnosis. Further research is necessary to select populations that may benefit from more effective and individualized treatment.
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- 2021
24. Patent Foramen Ovale Closure and Decompression Sickness Among Divers
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Samir R. Kapadia, Ahmed Sayed, Yehia Saleh, George S. Abela, Hani Jneid, Malak Munir, Omar M Abdelfattah, and Islam Y. Elgendy
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medicine.medical_specialty ,business.industry ,Diving ,Incidence (epidemiology) ,medicine.medical_treatment ,Foramen Ovale, Patent ,General Medicine ,Decompression Sickness ,medicine.disease ,Surgery ,Decompression sickness ,Relative risk ,Meta-analysis ,Quality of Life ,medicine ,Patent foramen ovale ,Humans ,Embolization ,Cardiology and Cardiovascular Medicine ,business ,Adverse effect ,Stroke - Abstract
Background Decompression sickness is a diving-related disease that results in various clinical manifestations, ranging from joint pain to severe pulmonary and CNS affection. Complications of this disease may sometimes persist even after treatment with hyperbaric oxygen therapy . In addition, it may hamper the quality of life by forcing divers to restrict their recreational practice. The presence of a patent foramen ovale (PFO) increases the risk of decompression sickness by facilitating air embolization . Therefore, PFO closure may play a role in reducing such complications. However, PFO closure remains associated with its own set of risks and complications. We sought to assess the benefit and harm of PFO closure for the prevention of decompression sickness in divers. Methods We conducted a comprehensive search of MEDLINE, Embase , CENTRAL, and Web of Science . Two-armed studies comparing the incidence of decompression sickness with or without PFO closure were included. We used a random-effects model to compute risk ratios comparing groups undergoing PFO closure to those not undergoing PFO closure. Results Four observational studies with a total of 309 divers (PFO closure: 141 and no closure: 168) met inclusion criteria. PFO closure was associated with a significantly lower incidence of decompression sickness (PFO-closure: 2.84%; no closure: 11.3%; RR: 0.29; 95% CI: 0.10 to 0.89; NNTB = 11), with low heterogeneity (I2 = 0%). The mean follow-up was 6.12 years (Standard deviation 0.70). Adverse events occurred in 7.63% of PFO closures, including tachyarrhythmias and bleeding. Conclusion PFO closure may potentially reduce the risk of decompression sickness among divers; however, it is not free of potential downsides, with nearly one in thirteen patients in our analysis experiencing an adverse event.
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- 2022
25. Frequency of Cardiac Arrhythmias in Children with Cardiological Consulting and Containing Electrocardiogram
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Fariba Tarhani, Fatemeh Oliaee, Ghobad Heidari, and Alireza Nezami
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Heart Septal Defects, Ventricular ,Bradycardia ,Tachycardia ,medicine.medical_specialty ,Heart disease ,Ventricular tachycardia ,Electrocardiography ,Postoperative Complications ,Internal medicine ,Junctional ectopic tachycardia ,medicine ,Humans ,cardiovascular diseases ,Child ,Pharmacology ,business.industry ,Infant ,Arrhythmias, Cardiac ,Atrial fibrillation ,Hematology ,General Medicine ,Right bundle branch block ,medicine.disease ,Cross-Sectional Studies ,cardiovascular system ,Patent foramen ovale ,Cardiology ,Molecular Medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Heart diseases are the leading causes of mortality and Congenital Heart Disease (CHD) is the most common birth defect reported worldwide. Objective: The aim of this study was to evaluate the incidence of arrhythmias and CHD and the association between the two, among infants and children reported to our center. Methods: This cross-sectional study included infants and children who were referred to Shahid Madani Hospital, Khorramabad. Electrocardiogram (ECG) was performed in these children to determine the type of arrhythmia and records were used to obtain demographic data and the data regarding CHD. Results : Of 200 children enrolled in the study, 10 children had arrhythmias, 12 had tachycardia, 5 had bradycardia, and 31 had congenital disease. Among children with arrhythmias, 1 had atrial fibrillation, 4 patients had paroxysmal supraventricular tachycardia, 1 person had right bundle branch block, 1 had ventricular tachycardia, 2 had premature ventricular contractions and 1 had junctional ectopic tachycardia. Of the 31 children with CHD, 9 patients were presented with small ventricular septal defect, 4 children had patent foramen ovale, 2 had pulmonary stenosis and 1 of the children had tetralogy of fallout, arterial and ventricular septal defects and transposition of greater arteries, respectively. Conclusion: We reported a positive correlation between the arrhythmias and CHD. A larger number of studies collecting focusing on different age groups are therefore required to verify our findings.
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- 2021
26. Safety and Cost Implications of Same-Day Discharge Following Elective Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defects in Australia
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Sanjana Shah, Kurt Mitchell, Abhisheik Prashar, Mark Sader, and Richard Zhang
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medicine.medical_specialty ,Heart septal defect ,Percutaneous ,Heart disease ,business.industry ,patient discharge ,Context (language use) ,atrial ,medicine.disease ,Atrial septal defects ,Surgery ,patent ,medicine.anatomical_structure ,foramen ovale ,length of stay ,medicine ,Patent foramen ovale ,Medicine ,heart septal defects ,business ,health care economics and organizations ,Mace ,Foramen ovale (heart) - Abstract
Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.
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- 2021
27. Association between acute myocardial infarction and death in 386 patients with a thrombus straddling a patent foramen ovale
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Maria Bres-Bullrich, Amado Jiménez-Ruiz, Andrew Gibson, Palak Shah, Juan C. Vargas-González, Luciano A. Sposato, and Rodrigo Bagur
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Adult ,medicine.medical_specialty ,Myocardial Infarction ,Foramen Ovale, Patent ,Logistic regression ,Coronary artery disease ,Paradoxical embolism ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,Myocardial infarction ,Thrombus ,Acute mi ,business.industry ,Thrombosis ,Middle Aged ,medicine.disease ,Stroke ,Cardiology ,Patent foramen ovale ,Female ,Risk of death ,Cardiology and Cardiovascular Medicine ,business ,Embolism, Paradoxical - Abstract
Right atrial thrombi are rarely found straddling a patent foramen ovale (PFO). A thrombus straddling a PFO (TSPFO), also known as impending paradoxical embolism, is a medical emergency associated with up to 11.5% risk of death within 24 h of being diagnosed. We hypothesized that acute myocardial infarction (MI) and ischemic stroke (IS) diagnosed upon the admission of patients with TSPFO are associated with increased risk of death. We also investigated if specific acute therapies are associated with reduced in-hospital mortality.We performed a systematic search including case reports and series of adult patients with TSPFO published from 1950 to October 30, 2020. We gathered patient-level data and we applied a logistic regression model to evaluate on the risk of in-hospital death. We performed time-trends and several sensitivity analyses.We included 386 cases with a TSPFO comprised in 359 publications. The median age was 61 years and 51.2% were females. Fifty (13.0%) patients died during hospital stay, 82 (21.2%) had an acute IS, and 18 (4.6%) had an acute MI diagnosed upon admission. Acute MI (OR 7.83, 95%CI 2.70-22.7; P 0.0001), but not IS, was associated with increased risk of death. Right atrial thrombectomy was associated with a 65% decreased in-hospital mortality (OR 0.35, 95%CI 0.18-0.70, P = 0.003). Results remained unchanged on sensitivity analyses.In this systematic review of 386 cases of TSPFO, acute MI but not IS was associated with 8-fold increased risk of death, while surgical thrombectomy was associated with a significant 65% reduction of in-hospital mortality.
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- 2021
28. Clinical Experience of Percutaneous Patent Foramen Ovale Closure Using the Amplatzer PFO Occluder in Japanese Patients to Prevent the Recurrence of Cryptogenic Stroke
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Hiroya Takafuji, Hiroyuki Watanabe, Nahoko Kato, Kotaro Obunai, and Yu Makihara
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Adult ,Cardiac Catheterization ,medicine.medical_specialty ,Percutaneous ,Septal Occluder Device ,patent foramen ovale ,medicine.medical_treatment ,Deep vein ,Foramen Ovale, Patent ,amplatzer PFO occluder ,Balloon ,Paradoxical embolism ,Japan ,Internal Medicine ,medicine ,Valsalva maneuver ,Humans ,Aged ,Ischemic Stroke ,Retrospective Studies ,business.industry ,General Medicine ,Middle Aged ,percutaneous PFO closure ,medicine.disease ,Thrombosis ,Surgery ,Stroke ,Cryptogenic stroke ,Treatment Outcome ,medicine.anatomical_structure ,cryptogenic stroke ,Patent foramen ovale ,Female ,Original Article ,Neoplasm Recurrence, Local ,business - Abstract
Objective Percutaneous patent foramen ovale (PFO) closure is a procedure widely used to prevent recurrence of cryptogenic stroke. Since December 2019, the Amplatzer PFO occluder device has been available in Japan through medical insurance. However, data on the clinical experience with this device are lacking, as it has been approved for use in only a limited number of institutions. This study assessed the clinical data of Japanese patients who underwent PFO closure using the Amplatzer PFO occluder. Methods Between February and October 2020, 14 patients at our institution underwent percutaneous PFO closure using the Amplatzer PFO occluder. The procedural characteristics, safety, and adverse events were retrospectively analyzed. Results The mean age of the patients was 52.4±13.3 years old, and 57.1% were women. Deep vein thrombosis was revealed in 2 patients, and the risk of paradoxical embolism score was 6.6±1.2 points. The PFO height and tunnel length were 2.3±1.4 mm and 11.5±4.1 mm. All patients had a PFO during the bubble study of grade >3 at the Valsalva maneuver on transthoracic echocardiography or transesophageal echocardiography. The average diameter of the PFO measured using a stiff guidewire and sizing balloon was 5.1±1.3 and 7.9±2.3 mm, respectively. Almost all cases (92.9%) were performed with a 25-mm device and without significant complications within approximately 1 hour. Conclusion Percutaneous closure using Amplatzer PFO occluder is a safe procedure for Japanese patients. However, further investigations with a larger sample and longer follow-up are needed to confirm this result.
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- 2021
29. Off-Pump Minithoracotomy Versus Sternotomy for Left Anterior Descending Myocardial Bridge Unroofing
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Shari L. Miller, Simar S. Bajaj, Jennifer A. Tremmel, Camille E. Hironaka, Ian S. Rogers, Hanjay Wang, Jack H. Boyd, Christian T. O’Donnell, R. Scott Mitchell, Chad J. Abbot, Ingela Schnittger, Vedant S. Pargaonkar, Michael P. Fischbein, and Yasuhiro Honda
- Subjects
Adult ,Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,Myocardial bridge ,medicine.medical_specialty ,Coronary Vessel Anomalies ,medicine.medical_treatment ,Population ,law.invention ,Angina ,law ,medicine.artery ,medicine ,Cardiopulmonary bypass ,Humans ,Abnormalities, Multiple ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Decision Trees ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Sternotomy ,Surgery ,Thoracotomy ,Concomitant ,Pulmonary artery ,Patent foramen ovale ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Myocardial bridge (MB) of the left anterior descending (LAD) coronary artery occurs in approximately 25% of the population. When medical therapy fails in patients with a symptomatic, hemodynamically significant MB, MB unroofing represents the optimal surgical management. Here, we evaluated minimally invasive MB unroofing in selected patients compared with sternotomy.MB unroofing was performed in 141 adult patients by sternotomy on-pump (ST-on, n = 40), sternotomy off-pump (ST-off, n = 62), or minithoracotomy off-pump (MT, n = 39). Angina symptoms were assessed preoperatively and 6 months postoperatively using the Seattle Angina Questionnaire. Matching included all MT patients and 31 ST-off patients with similar MB characteristics, no previous cardiac operations or coronary interventions, and no concomitant procedures.MT patients tended to have a shorter MB length than ST-on and ST-off patients (2.57 vs 2.93 vs 3.09 cm, P = .166). ST-on patients had a longer hospital stay than ST-off and MT patients (5.0 vs 4.0 vs 3.0 days, P .001), and more blood transfusions (15.2% vs 0.0% vs 2.6%, P = .002). After matching, MT patients had a shorter hospital stay than ST-off patients (3.0 vs 4.0 days, P = .005). No deaths or major complications occurred in any group. In all groups, MB unroofing yielded significant symptomatic improvement regarding physical limitation, angina stability, angina frequency, treatment satisfaction, and quality of life.We report our single-center experience of off-pump minimally invasive MB unroofing, which may be safely performed in carefully selected patients, yielding dramatic improvements in angina symptoms at 6 months after the operation.
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- 2021
30. Patent Foramen Ovale Closure Decreases the Incidence but Not the Size of New Brain Infarction on Magnetic Resonance Imaging: An Analysis of the REDUCE Trial
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Helle K. Iversen, John F. Rhodes, Grethe Andersen, Michel Bilello, Risto O. Roine, Lars Søndergaard, Scott E. Kasner, Steven R. Messé, Christos Davatzikos, Christina Sjöstrand, and Guray Erus
- Subjects
Brain Infarction ,medicine.medical_specialty ,Closure (topology) ,Foramen Ovale, Patent ,Article ,Internal medicine ,medicine ,Humans ,Clinical Trials ,cardiovascular diseases ,Advanced and Specialized Nursing ,End point ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,Stroke ,Ischemic Attack, Transient ,Brain infarction ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Patent foramen ovale ,Cardiology ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Supplemental Digital Content is available in the text., Background and Purpose: Randomized patent foramen ovale closure trials have used open-label end point ascertainment which increases the risk of bias and undermines confidence in the conclusions. The Gore REDUCE trial prospectively performed baseline and follow-up magnetic resonance imaging (MRIs) for all subjects providing an objective measure of the effectiveness of closure. Methods: We performed blinded evaluations of the presence, location, and volume of new infarct on diffusion-weighted imaging of recurrent clinical stroke or new infarct (>3 mm) on T2/fluid attenuated inversion recovery from baseline to follow-up MRI at 2 years, comparing closure to medical therapy alone. We also examined the effect of shunt size and the development of atrial fibrillation on infarct burden at follow-up. Results: At follow-up, new clinical stroke or silent MRI infarct occurred in 18/383 (4.7%) patients who underwent closure and 19/177 (10.7%) medication-only patients (relative risk, 0.44 [95% CI, 0.24–0.81], P=0.02). Clinical strokes were less common in closure patients compared with medically treated patients, 5 (1.3%) versus 12 (6.8%), P=0.001, while silent MRI infarcts were similar, 13 (3.4%) versus 7 (4.0%), P=0.81. There were no differences in number, volumes, and distribution of new infarct comparing closure patients to those treated with medication alone. There were also no differences of number, volumes, and distribution comparing silent infarcts to clinical strokes. Infarct burden was also similar for patients who developed atrial fibrillation and for those with large shunts. Conclusions: The REDUCE trial demonstrates that patent foramen ovale closure prevents recurrent brain infarction based on the objective outcome of new infarcts on MRI. Only clinical strokes were reduced by closure while silent infarctions were similar between study arms, and there were no differences in infarct volume or location comparing silent infarcts to clinical strokes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00738894.
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- 2021
31. Blood‐filled cyst of the tricuspid valve: Multiple cardiac disorders, one surgical case
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Béla Merkely, Bálint Károly Lakatos, Beáta Nagy, Kálmán Benke, Zoltán Szabolcs, István Hartyánszky, Cristina M. Șulea, Attila Kovács, E.D Merkel, Emese Csulak, Ferenc Imre Suhai, and Miklós Pólos
- Subjects
Pulmonary and Respiratory Medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Tricuspid valve ,business.industry ,medicine.disease ,Intracardiac injection ,Cardiac surgery ,Aortic aneurysm ,Bicuspid aortic valve ,medicine.anatomical_structure ,Right coronary artery ,medicine.artery ,cardiovascular system ,Patent foramen ovale ,Medicine ,Surgery ,Cyst ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND Intracardiac blood cysts are an exceedingly rare occurrence in adulthood. Detailed imaging modalities aid in the diagnosis of such incidental lesions and procedure planning. METHODS We report the case of a 51-year-old male accusing dyspnea on exertion as a sole symptom which led to the discovery of multiple cardiac anomalies, namely, severe aortic valve insufficiency on a bicuspid aortic valve, ascending aortic aneurysm, a cystic mass on the tricuspid valve, patent foramen ovale, and an occluded right coronary artery. RESULTS The disorders were managed in a single surgical intervention, the resected mass being confirmed as a blood cyst. CONCLUSIONS Our case presents a unique association of cardiac disorders, including a highly uncommon intracardiac blood-filled cyst, and underlines the importance of multimodality imaging and interdisciplinary approach in the successful management of such complex cases.
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- 2021
32. Cardiovascular considerations for scuba divers
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Jonathan H. Kim, Jason Tso, and Joshua M Powers
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medicine.medical_specialty ,business.industry ,Hydrostatic pressure ,Cardiomyopathy ,medicine.disease ,Plasma volume ,Article ,Scuba diving ,Coronary artery disease ,Decompression sickness ,Embolism ,medicine ,Patent foramen ovale ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,human activities - Abstract
As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses and risks inherent to this activity. Scuba presents a formidable cardiovascular challenge by combining unique environmental conditions with the physiologic demands of underwater exercise. Haemodynamic stresses encountered at depth include increased hydrostatic pressure leading to central shifts in plasma volume coupled with cold water stimuli leading to simultaneous parasympathetic and sympathetic autonomic responses. Among older divers and those with underlying cardiovascular risk factors, these physiologic changes increase acute cardiac risks while diving. Additional scuba risks, as a consequence of physical gas laws, include arterial gas emboli and decompression sickness. These pathologies are particularly dangerous with altered sensorium in hostile dive conditions. When present, the appropriate management of patent foramen ovale (PFO) is uncertain, but closure of PFO may reduce the risk of paradoxical gas embolism in divers with a prior history of decompression sickness. Finally, similar to other Masters-level athletes, divers with underlying traditional cardiovascular risk should undergo complete cardiac risk stratification to determine ‘fitness-to-dive’. The presence of undertreated coronary artery disease, occult cardiomyopathy, channelopathy and arrhythmias must all be investigated and appropriately treated in order to ensure diver safety. A patient-centred approach facilitating shared decision-making between divers and experienced practitioners should be utilised in the management of prospective scuba divers.
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- 2021
33. Prevalence of Patent Foramen Ovale in a Cohort of Children With Cryptogenic Ischemic Stroke
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Lauren A. Beslow, Evelyn K. Shih, Christine B. Falkensammer, Shobha Natarajan, Rebecca Ichord, and Steven R. Messé
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medicine.medical_specialty ,Foramen Ovale, Patent ,symbols.namesake ,Recurrence ,Risk Factors ,Internal medicine ,Prevalence ,medicine ,Humans ,Child ,Stroke ,Fisher's exact test ,Ischemic Stroke ,Proportional hazards model ,business.industry ,medicine.disease ,Ischemic stroke ,Cohort ,Cardiology ,symbols ,Patent foramen ovale ,Etiology ,Neurology (clinical) ,Transthoracic echocardiogram ,business - Abstract
Background and ObjectivesTo determine the significance of patent foramen ovale (PFO) in childhood stroke, we compared PFO prevalence, PFO features, and stroke recurrence risk in 25 children with cryptogenic arterial ischemic stroke (AIS), 54 children with AIS from a known etiology, and 209 healthy controls.MethodsWe performed a case-control analysis of a 14-year prospectively enrolled single-center cohort of children with AIS who underwent transthoracic echocardiogram (TTE) and compared them to TTEs of otherwise healthy children evaluated for benign cardiac concerns. Stroke patients 29 days to 18 years of age at stroke ictus with confirmed acute AIS on imaging, availability of complete diagnostic studies of stroke risk factors, including TTE images available for central review, and at least 1 follow-up evaluation after index stroke were included. Presence of PFO and high-risk PFO features were assessed by 2 independent, blinded reviewers and compared between groups with the Fisher exact test. Stroke/TIA recurrence risk was determined from Cox proportional hazards models.ResultsOf 154 children with first-ever AIS, 79 were eligible; 25 had cryptogenic AIS, and 54 had a known cause. PFO prevalence was higher in the cryptogenic group (7, 28%) compared to both the known stroke etiology group (3, 5.6%, p = 0.009) and controls without stroke (24, 11.5%, p = 0.03). There were no significant differences in presence of right-to-left shunt and atrial septal aneurysm. Median follow-up time for entire stroke cohort was 20.9 months. Stroke-free recurrence at 2-years did not differ between children with and without PFO (HR 2.0, 95% CI 0.4–9.3, p = 0.39).DiscussionPFO prevalence was higher in children with cryptogenic stroke compared to patients with AIS with known etiology and healthy controls. PFO was not associated with increased recurrence risk. Optimal secondary preventive treatment in children with cryptogenic stroke and PFO remains uncertain and requires further study.Classification of EvidenceThis study provides Class III evidence that children with cryptogenic ischemic stroke have an increased frequency of PFO compared to children with ischemic stroke of known etiology and healthy controls.
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- 2021
34. Large paradoxical embolus through a patent foramen ovale following arteriovenous graft thrombectomy
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Zeina Kadri, Chadi Allam, and Rabih R. Azar
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Arteriovenous fistula ,medicine.disease ,Thrombosis ,Surgery ,medicine.anatomical_structure ,Paradoxical embolism ,Ventricle ,Mitral valve ,cardiovascular system ,medicine ,Patent foramen ovale ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Embolization ,Thrombus ,Cardiology and Cardiovascular Medicine ,business - Abstract
An 86-year-old man with end-stage renal disease on hemodialysis with an arteriovenous fistula in his left upper extremity presented to his hemodialysis session with thrombosis of his arteriovenous fistula. The patient underwent surgical thrombectomy. The patient later showed evidence of peripheral embolization and livedo reticularis. Transthoracic and transesophageal echocardiograms revealed a large thrombus (5x2 cm) in the left atrium prolapsing to the right atrium via a patent foramen ovale and another thrombus (white arrow) adherent to the apical wall of the right ventricle. The thrombus in the left atrium was intermittently crossing the mitral valve and entering the left ventricle.
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- 2021
35. Genç inmeli hastalarda trombofili durumunun kısa dönem sonlanım ile ilişkisi
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Tea Beqiroski, Cihat Uzunköprü, and Esra Başkurt
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Pediatrics ,medicine.medical_specialty ,business.industry ,Thrombophilia ,medicine.disease ,Outcome (game theory) ,Term (time) ,Ischemic stroke ,medicine ,Patent foramen ovale ,General Earth and Planetary Sciences ,Young adult ,business ,General Environmental Science - Abstract
Purpose: Ischemic stroke is a serious health condition in patients with young adults. This study aims to determine thrombophilia polymorphisms in young patients with ischemic stroke and associations with other risk factors. Materials and Methods: We evaluated 64 patients with ischemic stroke under 50 years old. Computerized Tomography Angiography, Holter Electrocardiography, Transthoracic Echocardiography, thrombophilia status, and Modifying Rankin Scale (MRS) in baseline and first month findings were recorded. We analysed the association between thrombophilia status and short-term outcome in young adults with ischemic stroke. Results: 64 patients (38 male, 59.4%) were included in our study. The mean age of the patients were 42.486.73. The thrombophilia status showed that the most frequent polymorphism was MTHFRA1298T mutation (18.8% homozygous, 43.7% heterozygous). The second was MTHFRC677T and the third polymorphism was Factor 5 Leiden mutation, of 21.8% was homozygous and 34.4% was heterozygous mutation. 7.8% of the patients have atrial fibrillation, 17.2% of them have patent foramen ovale, and 7.8% have elevated pulmonary artery pressure (>30 mmHg). Thrombophilia status and PFO were not associated with IS in young adults. Conclusion: Young patients with ischemic stroke have several thrombophilial polymorphism; however, we did not detect any association with IS. Young patients with ischemic stroke have also many classic risk factors which should be treated appropriately. Patent foramen ovale is another remarkable pathology and more researches are needed to realize its relation with ischemic stroke in young adults.
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- 2021
36. Interventional prevention of paradoxical embolism as the gold standard: End of discussion?
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Petr Heinc, Radomir Nykl, Martin Sluka, David Richter, Jan Precek, Milos Taborsky, and Stepan Hudec
- Subjects
Cardiac Catheterization ,medicine.medical_specialty ,medicine.drug_class ,patent foramen ovale ,Population ,Foramen Ovale, Patent ,030204 cardiovascular system & hematology ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Paradoxical embolism ,Pharmacotherapy ,Intervention (counseling) ,medicine ,Humans ,Closure (psychology) ,education ,Intensive care medicine ,Ischemic Stroke ,education.field_of_study ,interatrial septal aneurysm ,business.industry ,Anticoagulant ,Gold standard ,paradoxical embolism ,medicine.disease ,Stroke ,Treatment Outcome ,030220 oncology & carcinogenesis ,Patent foramen ovale ,Medicine ,catheterization pfo closure ,business ,Embolism, Paradoxical - Abstract
Paradoxical embolism is one of the predominant causes of cryptogenic stroke and interventional secondary prevention, i.e., closure of the patent foramen ovale (PFO), is a much discussed issue. This review aims to provide a complex perspective on this topic, aggregates and comments on the available data and current guidelines. Several large trials were performed, some of which proved the superiority of PFO closure over pharmacotherapy while others have not. Studies detecting significant superiority of intervention worked with disproportionately high representation of large shunts compared to the general population. Other controversies also remain, such as the lack of comparison of the effect of modern anticoagulant/antiplatelet treatment to PFO closure or the risk of developing unwanted side effects after intervention, and these are discussed in detail. PFO closure is a suitable method for secondary prevention of paradoxical embolism and, therefore, cryptogenic stroke. However, this is only true for carefully selected patient populations and such selection is of the utmost importance in deciding on interventional or conservative treatment.
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- 2021
37. Contemporary Management of Patent Foramen Ovale: A Multinational Survey on Cardiologists’ Perspective
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Dariusz Dudek, Andrew Wiper, Halia Alshehri, David H. Roberts, David Hildick-Smith, Christopher J. White, Marloe Prince, Maciej Dębski, Shajil Chalil, and Amr Abdelrahman
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Intracardiac echocardiography ,Article Subject ,MEDLINE ,Foramen Ovale, Patent ,Cardiologists ,Recurrence ,Surveys and Questionnaires ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Radiology, Nuclear Medicine and imaging ,Stroke ,business.industry ,Standardized approach ,Perspective (graphical) ,medicine.disease ,Ecg monitoring ,Treatment Outcome ,Ischemic Attack, Transient ,Multinational corporation ,RC666-701 ,Patent foramen ovale ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business ,Research Article - Abstract
Objectives. The purpose of our survey is to analyze the clinical approach used by interventional and imaging cardiologists to diagnose, treat, and follow-up patients with PFO-related left circulation thromboembolism in different parts of the world with particular emphasis on adherence to current guidelines. Background. Firm guidelines do not cover many aspects of PFO-related patient care. Consequently, very disparate approaches exist among clinicians in the real-world. Methods. A 24-item electronic questionnaire was sent directly to experienced cardiology specialists practicing at consultant/attending positions directly involved in PFO closure management in the United States, United Kingdom, Gulf countries, and other countries. There were no unanswered questions. Responses were recorded between October 2019 and July 2020. Results. Seventy-one responses were obtained: 31 from the UK, 19 from the US, 16 from Gulf countries, 2 from Poland, and 1 response from Australia, Italy, and Switzerland. The overall response rate was 76%. Significant differences between regions were noted in the duration of ECG monitoring during the diagnostic process, PFO closure for left circulation thromboembolism other than stroke/transient ischemic attack, and intraoperative use of intracardiac echocardiography. A similar pattern was noted in the lack of routine screening for thrombophilia and the use of the long-term single antiplatelet therapy. Conclusions. The study shows a vast spectrum of opinions on the optimal approach to PFO closure with significant differences between the US, UK, and Gulf countries. The results stress the need for systematic, high-quality data on the diagnostic work-up and follow-up strategies to inform the standardized approach.
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- 2021
38. Lacunar cerebral infarction following endovascular interventions for phlegmasia cerulea dolens
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Eric D. Martin, Maeghan L. Ciampa, and Ashley M. Otto
- Subjects
medicine.medical_specialty ,RD1-811 ,030204 cardiovascular system & hematology ,Inferior vena cava ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Case report ,medicine ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,Thrombus ,Thrombectomy ,Phlegmasia cerulea dolens ,Endovascular ,Cerebral infarction ,business.industry ,medicine.disease ,Lacunar infarct ,Surgery ,Expressive aphasia ,medicine.vein ,RC666-701 ,Middle cerebral artery ,Deep venous thrombosis ,cardiovascular system ,Patent foramen ovale ,Endovascular interventions ,Cardiology and Cardiovascular Medicine ,business - Abstract
Phlegmasia cerulea dolens is a rare presentation of deep venous thrombus treated with catheter directed thrombolysis and pharmacomechanical thrombectomy. This is the case of a 78-year-old woman who underwent catheter directed thrombolysis to treat phlegmasia cerulea dolens and subsequently developed left-sided hemiplegia and expressive aphasia in the setting of an international normalized ratio of 2.0. Further imaging revealed a lacunar infarct in the right thalamus with a middle cerebral artery distribution. Further workup revealed a patent foramen ovale. We highlight the unexpected enigmatic consequence from multimodal endovascular intervention, the consequence of long-term inferior vena cava filters.
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- 2021
39. Post-Market Clinical Follow-Up With the Patent Foramen Ovale Closure Device IrisFIT (Lifetech) in Patients With Stroke, Transient Ischemic Attack, or Other Thromboembolic Events
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Horst Sievert, Predrag Matic, Kolja Sievert, Ilona Hofmann, Sameer Gafoor, Nalan Schnelle, Ralph Stephan von Bardeleben, Marius Hornung, Stefan Bertog, Iris Q. Grunwald, Jiangtao Yu, and Markus Reinartz
- Subjects
Cardiac Catheterization ,medicine.medical_specialty ,Percutaneous ,Septal Occluder Device ,Foramen Ovale, Patent ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Paradoxical embolism ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Thrombus ,business.industry ,Atrial fibrillation ,General Medicine ,medicine.disease ,Stroke ,Catheter ,Treatment Outcome ,Ischemic Attack, Transient ,Patent foramen ovale ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Shunt (electrical) ,Follow-Up Studies - Abstract
Background A patent foramen ovale (PFO) has been associated with embolic strokes and transient ischemic attacks (TIAs). Catheter closure of PFO is effective in preventing recurrent events. Residual shunts and procedure or device related complications can occur, including atrial fibrillation and thrombus formation . This study examines the initial experience with a new PFO closure device, the IrisFIT PFO-Occluder (Lifetech Scientific, Shenzhen, China). Methods 95 patients with indications for PFO closure underwent percutaneous closure with the IrisFIT PFO-Occluder. The primary endpoint was the rate of accurate device placement with no/small residual shunt at 3 or 6 months follow-up. All patients underwent transoesophageal echocardiography (TEE) after 1 to 6 months. In case of a residual shunt, an additional TEE was performed after 12 months. Clinical follow-up was performed up to a mean of 33.1 ± 3.6 months. Results The device was successfully implanted in 95 (100%) patients with no relevant procedural complications. At final TEE follow-up (7.6 ± 3.9 months) the effective closure rate was 96.8% with 1 moderate and 2 large residual shunts. There were 8 cases of new onset atrial fibrillation and 2 TIAs. There were no cases of device embolization or erosion. Conclusion The IrisFIT occluder is a new PFO closure device with several advantages compared to other devices. In this small study cohort , technical success rate, closure rate and adverse event rate were comparable to other devices. The rate of new onset atrial fibrillation was higher in comparison to other studies and warrants further investigation.
- Published
- 2021
40. Clinical manifestation and imaging characteristics of transient global amnesia: patent foramen ovale as an underlying factor
- Author
-
Hyun Goo Kang and Sang-Mi Noh
- Subjects
Adult ,Male ,medicine.medical_specialty ,patent foramen ovale ,Ischemia ,Foramen Ovale, Patent ,Neurosciences. Biological psychiatry. Neuropsychiatry ,Clinical manifestation ,cerebral ischemia ,Brain Ischemia ,Lesion ,Amnesia, Transient Global ,Internal medicine ,medicine ,Foramen ,Humans ,medicine.diagnostic_test ,business.industry ,General Neuroscience ,Magnetic resonance imaging ,transient global amnesia ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Cardiology ,Transient global amnesia ,Patent foramen ovale ,Etiology ,Female ,medicine.symptom ,business ,RC321-571 - Abstract
Transient global amnesia is not rare, but its etiology remains unknown. Cerebral ischemia is a suspected cause because high signal intensity is observed on diffusion-weighted brain magnetic resonance imaging; however, previous studies have not established it as a cause. Of the 128 patients (114 females) enrolled in this study, 82 (64.6%) experienced extreme stress before transient global amnesia. The number of female patients with patent foramen ovale was more than that of males. The patent foramen ovale-positive group had fewer vascular risk factors and fewer old ischemic lesions on fluid-attenuated inversion recovery magnetic resonance imaging than the patent foramen ovale-negative group. Brain magnetic resonance imaging confirmed that high signal intensity was more likely to be detected on the initial diffusion-weighted imaging when there was an old lesion detected by fluid-attenuated inversion recovery. Furthermore, a longer period from symptom onset to brain magnetic resonance imaging was associated with a positive initial diffusion-weighted imaging result. It is difficult to attribute one underlying mechanism to all the transient global amnesia cases. This study confirmed that transient global amnesia patients with patent foramen ovale had lesser vascular risk factors and showed fewer old lesions on fluid-attenuated inversion recovery magnetic resonance imaging than those without. These results suggest that transient global amnesia may be caused by a paradoxical embolus rather than ischemia due to traditional vascular risk factors in patients with patent foramen ovale.
- Published
- 2021
41. Simultaneous acute limb ischemia related to acute Leriche syndrome and pulmonary embolism without existing patent foramen ovale: a case report
- Author
-
Ying-Sheng Li and Ying-Ching Li
- Subjects
medicine.medical_specialty ,Orthopnea ,Intracardiac right-to-left shunt ,medicine.diagnostic_test ,business.industry ,Pulmonary embolism ,Aortoiliac occlusion ,Acute Leriche syndrome ,Case Report ,medicine.disease ,Patent foramen ovale ,Surgery ,Coronary artery disease ,RC666-701 ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Artery occlusion ,Thrombus ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Leriche Syndrome ,Computed tomography angiography - Abstract
Background Aortoiliac occlusion disease, also called Leriche syndrome, is characterized by atherothrombotic obliteration of the aortic bifurcation and bilateral common iliac arteries; typically, it has a chronic presentation. Pulmonary embolism is more related to venous thromboembolism rather than arterial thromboembolic events. Therefore, cases of simultaneous acute Leriche syndrome and pulmonary embolism are rare. Existing intracardiac right-to-left shunt were detected in most previous cases. Herein, we present the first likely documented case wherein acute Leriche syndrome and pulmonary embolism occurred simultaneously without a patent foramen ovale. Case presentation A 58-year-old man with hyperlipidemia and coronary artery disease presented with a 4-h history of bilateral lower limb numbness. He was a heavy smoker with a history of stroke. Computed tomography angiography revealed pulmonary embolism and aortoiliac artery occlusion. Although a massive thrombus straddled the bilateral pulmonary arteries, orthopnea was his only presentation, without right ventricle failure. Cyanosis of the affected limbs was noted, and muscle strength in both limbs had regressed to grade 1. Owing to acute limb ischemia, he underwent an emergency operation to salvage the limbs. On postoperative day 5, the general condition of both the legs improved; the muscle strength improved to grade 4. He was then transferred to the general ward and enoxaparin was continued. Computed tomography angiography was repeated to evaluate the pulmonary embolism on postoperative day 8; the thrombus remained lodged in the bilateral main pulmonary arteries. Owing to persistent orthopnea and chest tightness with intermittent tachycardia, he underwent a staged operation for the pulmonary embolism on postoperative day 13. During the surgery, intraoperative transesophageal echocardiography showed no patent foramen ovale or an existing right-to-left shunt. Postoperatively, he was closely monitored in the intensive care unit for 3 days and then transferred to the general ward for 10 days. A final computed tomography angiography performed on postoperative day 18 revealed thrombus resolution. He was then discharged on postoperative day 30 without any in-hospital complications. Conclusion We present a case that might be the first documented report of acute Leriche syndrome co-occurring with pulmonary embolism without an existing patent foramen ovale.
- Published
- 2021
42. Society for Vascular Medicine Abstracts presented at the SVM 2021 Virtual Scientific Sessions
- Author
-
A. Perez
- Subjects
medicine.medical_specialty ,Purple toe syndrome ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Embolectomy ,Transesophageal echocardiogram ,medicine.disease ,Pulmonary embolism ,medicine.anatomical_structure ,Internal medicine ,cardiovascular system ,medicine ,Patent foramen ovale ,Cardiology ,cardiovascular diseases ,Thrombus ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business ,Interatrial septum - Abstract
Background: Right heart thrombi and thrombi in transit across a patent foramen ovale (PFO) are uncommonly seen in patients with pulmonary embolism (PE) and are associated with high risk of adverse outcomes. We present a case of bi-atrial thrombi and thrombus in transit in a patient with acute submassive PE. Methods/Case Description/Results: A 31-year-old male with no significant past medical history presented with 8 days of dyspnea on exertion and pleuritic chest pain. Computed tomography angiography showed large volume of bilateral PE with right ventricular (RV) strain and right atrial (RA) thrombus. He was hemodynamically stable. Cardiac biomarkers were elevated. COVID testing was negative. Pulmonary embolism response team (PERT) was activated. Transthoracic echocardiogram revealed severely dilated RV with severely reduced function. A mobile mass was seen in the RA, possibly anchored to the interatrial septum. An emergent transesophageal echocardiogram showed mobile thrombus within both atria and thrombus in transit through a PFO. After multidisciplinary PERT discussion, involving the patient and his family, decision was made to proceed with a surgical approach, including pulmonary artery and bi-atrial embolectomy, and PFO closure. Post-surgical recovery was uneventful, and he was discharged on aspirin and apixaban on postoperative day 6. Follow up TTE 4 weeks after discharge showed recovered RV size and function. The patient is back to normal functional status. Conclusion: Combined biatrial thrombi and thrombi in transit are rare in patients with PE. Multidisciplinary approach to such patients, taking into account risks and benefits of each treatment approach, and patient preferences, is of paramount importance to achieve optimal patient outcome..
- Published
- 2021
43. Multi-modal and multi-postural assessment of platypnea-orthodeoxia syndrome triggered by stroke: A case report
- Author
-
Keisuke Matsuo, Masanori Katayama, Kenji Fukushima, Shintaro Nakano, and Saki Hasegawa
- Subjects
medicine.medical_specialty ,Supine position ,medicine.diagnostic_test ,business.industry ,Case Report ,Sitting ,Scintigraphy ,medicine.disease ,Hypoxemia ,Internal medicine ,medicine ,Patent foramen ovale ,Etiology ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Shunt (electrical) - Abstract
Platypnea-orthodeoxia syndrome (POS) is a rare condition where patients suffer from dyspnea and reduced oxygenation while in the sitting position. A 69-year-old man initially experienced dyspnea and hypoxemia in the sitting position after developing hemiplegia and postural instability secondary to a cerebral hemorrhage, but the symptoms improved in the supine position. Transesophageal echocardiography revealed a patent foramen ovale (PFO). In the sitting or semi-Fowler position, increased right-left shunt was observed using Swan-Ganz catheterization and pulmonary perfusion scintigraphy. The PFO closure was performed, which obliterated dyspnea and hypoxemia in the sitting position. In POS associated with PFO, comprehensive pre-operative evaluation using multi-modality tests in different postural settings critically delineates the etiology that guides appropriate treatment strategy.
- Published
- 2022
44. Patent foramen ovale—When to close and how?
- Author
-
Sven Möbius-Winkler, Albrecht Günther, P. Christian Schulze, Marcus Franz, Carsten M. Klingner, Aurel Maloku, Ali Hamadanchi, and Gudrun Dannberg
- Subjects
medicine.medical_specialty ,business.industry ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Pfo closure ,Migraine ,Occlusion ,medicine ,Patent foramen ovale ,Number needed to treat ,Platelet aggregation inhibitor ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Foramen ovale (heart) - Abstract
Closure of a patent foramen ovale (PFO) in patients after cryptogenic/cardioembolic stroke is recommended by current guidelines for patients who are 16–60 years of age with a high-risk PFO (class of recommendation A, level of evidence I). The use of double-disk occlusion devices followed by antiplatelet therapy is recommended. The procedure of interventional PFO closure compared with other interventions in cardiology is rather easy to learn. However, it should be performed carefully to avoid postinterventional complications. The number needed to treat (NNT) to avoid one stroke in 5 years in the RESPECT trial was 42, in the CLOSE trial even lower with 20. In the REDUCE trial, the NNT was 28 at 2 years. This can be reduced by longer follow-up, e.g., at 10 years the NNT is 18. While other conditions such as migraine are currently under investigation with respect to the impact of PFO closure, sufficiently powered trials are lacking so that closure in diseases other than stroke should always be individualized.
- Published
- 2021
45. Multiple simultaneous embolic cerebral infarctions 11 months after COVID-19
- Author
-
Sebastian T Lugg, Rajiv Advani, Espen Stjernstrøm, and Torbjørn Austveg Strømsnes
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Population ,Case Report ,Disease ,Anticoagulation ,Coagulopathy ,Internal medicine ,medicine ,Diseases of the blood and blood-forming organs ,cardiovascular diseases ,Pulmonary Embolus ,education ,Stroke ,Angiology ,education.field_of_study ,business.industry ,COVID-19 ,Hematology ,Thrombolysis ,Emergency department ,medicine.disease ,Cardiology ,Patent foramen ovale ,RC633-647.5 ,business - Abstract
Background The coronavirus disease (COVID-19) pandemic has led to an unprecedented worldwide burden of disease. However, little is known of the longer-term implications and consequences of COVID-19. One of these may be a COVID-19 associated coagulopathy that can present as a venous thromboembolism (VTE) and further, as multiple paradoxical cerebral emboli. Case presentation A 51 year old man presented to the emergency department with multiple simultaneous embolic cerebral infarctions 11 months after mild COVID-19. In the subacute phase of the COVID-19 illness the patient developed increasing shortness of breath and was found to have an elevated D-dimer and multiple bilateral segmental pulmonary emboli. He was subsequently treated with 3 months of anticoagulation for a provoked VTE. The patient then presented 11 months after the initial COVID-19 diagnosis with multiple simultaneous cerebral infarctions where no traditional underlying stroke etiology was determined. A patent foramen ovale (PFO) and an elevated D-dimer were found suggesting a paradoxical thromboembolic event due to an underlying coagulopathy. Conclusions This case report highlights the one of the potentially more serious complications of long-term COVID-19 where VTE due to a persistent coagulopathy is seen almost a year after the initial illness. Due to the highly prevalent nature of PFO in the general population, VTE due to COVID-19 associated coagulopathy could lead to ischemic stroke. This case report highlights the possibility for an underlying COVID-19 associated coagulopathy which may persist for many months and beyond the initial illness.
- Published
- 2021
46. Persistent pathology of the patent foramen ovale: a review of the literature
- Author
-
Phillip Lo, David Roy, Kenneth Cho, Shaun Khanna, and Daniel Cheng
- Subjects
Cardiac Catheterization ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Migraine Disorders ,Population ,Foramen Ovale, Patent ,Decompression illness ,General Medicine ,medicine.disease ,Surgery ,Dyspnea ,Treatment Outcome ,Paradoxical embolism ,Migraine ,Prevalence ,Patent foramen ovale ,medicine ,Humans ,Neurosurgery ,Migraine treatment ,business ,education ,Stroke ,Ischemic Stroke - Abstract
A patent foramen ovale (PFO) is an interatrial shunt, with a prevalence of 20-34% in the general population. While most people do not have secondary manifestations of a PFO, some reported sequelae include ischaemic stroke, migraine, platypnoea-orthodeoxia syndrome and decompression illness. Furthermore, in some cases, PFO closure should be considered for patients before neurosurgery and for patients with concomitant carcinoid syndrome. Recent trials support PFO closure for ischaemic stroke patients with high risk PFOs and absence of other identified stroke mechanisms. While PFOs can be associated with migraine with auras, with some patients reporting symptomatic improvement after closure, the evidence from randomised controlled trials is less clear in supporting the use of PFO closure for migraine treatment. PFO closure for other indications such as platypnoea-orthodeoxia syndrome, decompression illness and paradoxical embolism are based largely on case series with good clinical outcomes. PFO closure can be performed as a day surgical intervention with high procedural success and low risk of complications.
- Published
- 2021
47. Paradoxical brain embolism due to a popliteal venous aneurysm after minor orthopedic surgery in a 19-year-old man with patent foramen ovale: A case report
- Author
-
Makoto Eriguchi, Atsushi Ogata, Motoki Sonohata, Kazuki Muranaka, and Masaaki Mawatari
- Subjects
medicine.medical_specialty ,business.industry ,030204 cardiovascular system & hematology ,Venous aneurysm ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Orthopedic surgery ,Brain Embolism ,Patent foramen ovale ,Medicine ,Orthopedics and Sports Medicine ,business ,030217 neurology & neurosurgery - Published
- 2021
48. Large eustachian valve fostering paradoxical thromboembolism: passive bystander or serial partner in crime?
- Author
-
Eustaquio Maria Onorato
- Subjects
medicine.medical_specialty ,Percutaneous ,business.industry ,Eustachian valve ,Chiari’s network ,Right-to-left shunt ,Minireviews ,medicine.disease ,Paradoxical embolism ,Patent foramen ovale ,Eustachian Valve ,Shunting ,Catheter ,medicine.anatomical_structure ,Echocardiography ,Internal medicine ,medicine.artery ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Crista terminalis - Abstract
Catheter-based closure of patent foramen ovale (PFO) is more effective than medical therapy in the prevention of recurrent stroke[1]. It is likely that a proportion of patients evaluated for potential transcatheter PFO closure has actually different anatomical variants particularly common in the right atrium such as eustachian valve, Chiari network, Thebesian valve and Crista Terminalis. Notably, the eustachian valve may represent an increased risk factor for left circulation thromboembolism beyond that associated with PFO size and shunting. Such patients may benefit the most from percutaneous closure procedure.
- Published
- 2021
49. Multisystem thromboembolism in a COVID-19 patient: a case report
- Author
-
Moaaz Baghal, Mark Gabelman, Abraham Lo, Syed Imran Mustafa Jafri, Swati Govil, Rutwik Patel, Viralkumar Amrutiya, and Brandon Gaynor
- Subjects
medicine.medical_specialty ,pulmonary embolism ,Thrombus aspiration ,Coronavirus disease 2019 (COVID-19) ,Case Report ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Paradoxical embolism ,medicine ,ischemic stroke ,030212 general & internal medicine ,cardiovascular diseases ,dvt ,anticoagulation ,Stroke ,Internal medicine ,business.industry ,thromboembolism ,medicine.disease ,RC31-1245 ,Pulmonary embolism ,Surgery ,Venous thrombosis ,hypercoagulability ,covid-19 ,Ischemic stroke ,Patent foramen ovale ,business - Abstract
Hypercoagulability has been found in patients diagnosed with the novel coronavirus 19 (COVID-19) and has been identified as a major cause of morbidity and mortality. Herein, we report the challenge in managing a patient presenting with a 5 day history of COVID-19 diagnosis, complicated by deep venous thrombosis, pulmonary embolism and ischemic stroke in the setting of atrial septal aneurysm, presumed patent foramen ovale and paradoxical embolism, identified to have clots in transit on echocardiogram. The application of anticoagulation was felt to be high risk. The patient was transferred to a tertiary facility where the patient underwent thrombus aspiration and was eventually complicated by hemorrhagic conversion of the stroke.
- Published
- 2021
50. Central retinal artery occlusion associated with patent foramen ovale: a case report and literature review
- Author
-
Eric Shulman, Matthew S. Wieder, Joyce Mbekeani, Nancy Blace, Jincy Thankenchen, and Moshe M. Szlechter
- Subjects
medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Retinal Artery Occlusion ,CONGENITAL CARDIAC ANOMALY ,Transesophageal echocardiogram ,Foramen ovale, patent ,Transesophageal ,stomatognathic system ,Internal medicine ,Medicine ,cardiovascular diseases ,Retinal artery occlusion ,Foramen ovale (heart) ,Case reports ,medicine.diagnostic_test ,business.industry ,General Medicine ,RE1-994 ,medicine.disease ,Shunt (medical) ,Ophthalmology ,medicine.anatomical_structure ,Echocardiography ,Patent foramen ovale ,Cardiology ,cardiovascular system ,Central retinal artery occlusion ,Transthoracic echocardiogram ,business - Abstract
Patent foramen ovale might cause cryptogenic strokes, including retinal artery occlusion. Herein, we describe a previously healthy young man who presented with central retinal artery occlusion in the setting of patent foramen ovale and explore the need for transesophageal echocardiogram for its diagnosis. Cardiovascular workup and neuroimaging were unremarkable. Transthoracic echocardiogram bubble study revealed a right to left atrial shunt and subsequent transesophageal echocardiogram disclosed patent foramen ovale. This congenital cardiac anomaly was the likely conduit for a thrombo-embolic central retinal artery occlusion. We identified seven patients with patent foramen ovale associated with central retinal artery occlusion in the literature. Transthoracic echocardiogram was diagnostic in only one patient (14.3%), whereas transesophageal echocardiogram was required to reveal patent foramen ovale in the remaining six (85.7%). Our case and the previous reports support the link between central retinal artery occlusion and patent foramen ovale. Therefore, providers should consider the more sensitive transesophageal echocardiogram during the initial evaluation of young patients without immediately identifiable causes of retinal artery occlusion.
- Published
- 2021
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