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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patent foramen ovale (PFO) is more frequent in cryptogenic stroke patients than in the general population. The aim of this study was to determine prothrombotic markers regarding PFO in young cryptogenic stroke patients. We prospectively included consecutive cryptogenic stroke patients younger than 55 years. PFO was diagnosed with simultaneous transcranial Doppler and transesophageal echocardiography. We analyzed the following prothrombotic markers: antiphospholipid antibodies (APS), protein C and protein S deficiencies, factor V Leiden FVG1691A, prothrombin gene mutation PTG20210A and coagulation factor XII mutation FXIIC46T. From June 2005 to July 2006 we studied 39 patients, mean age 44.7 +/- 8.6 years, 48.7% men. PFO was detected in 17 patients (43.6%). We found no differences between PFO and non-PFO patients regarding prothrombotic markers: APS (P = 0.851), protein S deficiency (P = 0.851), protein C deficiency (P = 0.249), FVG1691A (P = 0.202), PTG20210A (P = 0.401) or FXIIC46T (P = 0.966). Female gender was the only variable related to prothrombotic markers, independent of PFO (P = 0.001). The only prothrombotic marker related to PFO size (large PFO) was APS (P = 0.043). Large PFO were also related to deep venous thrombosis (P = 0.040) and atrial septal aneurysm (P = 0.010). PFO patients do not present more prothrombotic markers than non-PFO patients, but APS are more frequent in large PFO.
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PMID:Patent foramen ovale and prothrombotic markers in young stroke patients. 1846 58

Patent foramen ovale (PFO) is a common congenital abnormality that has been implicated in a number of disease processes, including cryptogenic stroke and migraine headaches. Medical treatment for these processes is often considered inadequate and mechanical closure of the PFO is an attractive, albeit controversial, alternative. PFO closure has become common practice in many centers, although recent guidelines limit its indication to certain subsets of patients. This review first focuses on the anatomy, physiology and pathophysiology of PFO, and then reviews the currently available and experimental devices for PFO closure, as well as the present clinical data pertaining to them. Finally, we present our perspective of the PFO closure, with regard to its current use and future directions.
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PMID:Patent foramen ovale closure: past, present and future. 1786 18

Patent foramen ovale is a defect in the interatrial septum associated with cryptogenic stroke. The presumed mechanism of cryptogenic stroke due to a patent foramen ovale is the migration of thrombus from the venous side of the circulation to the left atrium with subsequent systematic embolism, called paradoxical embolization. Provacative maneuvers and pre-existing cardiopulmonary disease can cause elevation in right atrial pressure leading to right-to-left shunting through a patent foramen ovale. We report two patients with patent foramen ovale waking up with cryptogenic vascular events and found to have an obstructive sleep apnea syndrome. During nocturnal sleep, obstructive sleep apnea can cause right atrium pressure elevation resulting in right-to-left shunting through patent foramen ovale. The possibility of patent foramen ovale and an obstructive sleep apnea syndrome may be considered in patients with cryptogenic strokes-on-awakening. Further studies are needed to support our observation.
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PMID:Cerebrovascular events on awakening, patent foramen ovale and obstructive sleep apnea syndrome. 1808 76

Patent foramen ovale (PFO) is an anatomical variant of the interatrial septum with an overall prevalence of 27% in autopsy studies. PFOs have a potential role in causation of stroke, platypneaorthodeoxia, decompression sickness, right to left shunt and migraine headaches. Data regarding percutaneous closure of PFO in low volume tertiary care centers is lacking. Retrospective review of 14 percutaneous PFO closures done in our facility from March 2005 to August 2006 was performed for efficacy of procedure and safety. All patients received clopidogrel for a period of 3 months, and aspirin and subacute bacterial endocarditis prophylaxis for 6 months. Mean age of the study population was 54 years. Fifty percent (7 of 14) of patients experienced an atrial septal aneurysm and 14% (2 patients) exhibited a hypercoagulable state. The indication for closure in 13 patients was transient ischemic attacks or strokes, while one patient had persistent hypoxia due to a severe right to left shunt at PFO. Patients received either a CardioSEAL or Amplatzer device. Deployment rate was 100%. All patients completed a minimum of 6 months of follow-up, with a mean follow-up time of 14.9 +/- 7.6 months. No immediate or late bleeding complication occurred in any patient. One patient developed paroxysmal atrial fibrillation and one patient developed thrombotic complications at 7 months post-procedure secondary to the progression of her anal carcinoma and subsequently died. Pending the results of the four large randomized trials that are enrolling patients, percutaneous closure of PFO for cryptogenic strokes is an attractive alternative to lifelong anticoagulation with relatively few complications, even in low volume centers. There are many challenges in the management of this subset of patients, the foremost being the selection of a target patient population. Role of PFO in migraines is less clear.
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PMID:Percutaneous closure of patent foramen ovale: a case series and literature review. 1808 6

Patent foramen ovale (PFO) is a frequent finding on echocardiography and occurs in over 25% of the population. In young patients with cryptogenic stroke, the frequency is much higher suggesting paradoxical embolization may be responsible for the clinical events. There are conflicting data from studies examining the association between PFO and stroke. The combination of atrial septal aneurysm and PFO, and PFO size and severity of right-to-left shunt may add additional risk but again the data are insufficient for definite conclusions. Available information suggests no difference in subsequent stroke in patients with PFO treated with aspirin or warfarin for secondary prevention. Endovascular closure is technically feasible, but not without the possibility of periprocedural complications. Comparison of medical and endovascular closure of PFOs in patients with stroke is ongoing in 2 major randomized trials.
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PMID:PFO and stroke: what are the data? 1809 2

Patent foramen ovale (PFO) closure is reported to result in fewer episodes of clinically manifest recurrent cerebral ischemia than medical treatment. We evaluated by means of magnetic resonance imaging (MRI) whether silent cerebral ischemic episodes are also decreased by PFO closure. Seventy-one patients with PFO were selected for percutaneous closure of PFO at our center. All had PFO with large right-to-left shunt documented by transcranial Doppler ultrasound and transesophageal echocardiography, > or =1 previous stroke or transient ischemic attack with MRI documentation at the index event, and no alternative cause for cerebral ischemia. MRI studies were performed in all patients 24 hours before the procedure and at 1-year follow-up (or before in the case of a suspected new neurologic event). Eight patients (11%) had >1 clinical event before the procedure. Comparing the 2 MRI studies before the procedure, silent ischemic lesions were observed in 14 other patients (20%). Thus, considering clinical and silent events together, >1 event was present at baseline in 22 patients (31%). After PFO closure (follow-up 16 +/- 7 months), 1 recurrent neurologic event occurred (1%, p = 0.02 vs preprocedural clinical events); however, urgent brain MRI results were negative. Moreover, only 1 patient showed 1 new silent lesion at brain MRI at follow-up (1%, p <0.001 vs preprocedural silent brain lesions). Considering clinical and silent events, relapses occurred in 2 patients only (p <0.001 vs before procedure). Recurrent events were limited to those with incomplete PFO closure at postprocedural transcranial Doppler ultrasound (p = 0.02). In conclusion, percutaneous PFO closure results in few clinical or silent events after 1-year follow-up, especially when complete PFO closure is successfully accomplished.
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PMID:Clinical and brain magnetic resonance imaging follow-up after percutaneous closure of patent foramen ovale in patients with cryptogenic stroke. 1835 30

Patent foramen ovale (PFO) is associated with ischaemic stroke and migraine with aura (MA), and has been proposed as a cause of both. Numerous studies indicate that percutaneous PFO closure can improve MA, but they all suffer from methodological problems. It is recommended that the advantages and risks of PFO closure be carefully assessed in each individual, bearing in mind that effective prophylactic medications are available for MA patients with high attack frequency.
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PMID:Does closure of a patent foramen ovale have a role in the treatment of migraine with aura? 1854 90

Patent foramen ovale (PFO) is a congenital, small tunnel-like connection between the right and left atria that usually closes spontaneously after birth. However, frequently (in up to 35% of the normal population) it persists into adulthood. It is associated with 'paradoxical' embolism from the venous to the arterial system and may result in stroke or peripheral embolism. One prophylactic treatment option is transcatheter closure of the PFO. Currently available closure devices extend into both atria and therefore occasionally cause complications, such as thrombus formation or erosion of adjacent structures. The Coherex FlatStent is a flat, self-expanding stent that is designed to be positioned within the PFO tunnel. It is a very small, low-mass device that minimizes the amount of implanted foreign material to reduce the risk of device-related complications. This article focuses on the anatomy of PFOs and compares the Coherex FlatStent with currently available and experimental PFO closure devices.
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PMID:Percutaneous closure of patent foramen ovale with a novel FlatStent. 1857 42

Patent foramen ovale is a congenital cardiac lesion that persists into adulthood and which is present in over 25% of the adult population. Its diagnosis, evaluation and treatment have attracted increasing interest as it has been suggested that it may be associated with various pathologic conditions, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine. However, data on these associations are contradictory. Similarly, the optimum treatment of patients with patent foramen ovale is still debated. This article contains a review of the anatomy, embryology and epidemiology of the condition, its association with other clinical disorders, and current therapeutic options.
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PMID:[Patent foramen ovale: current state of the art]. 1859 Jun 47

Patent foramen ovale (PFO) is a relatively common congenital condition which has been implicated in cryptogenic stroke as a result of paradoxical thromboembolism by right-to-left shunting. Many studies have demonstrated that transcatheter PFO closure significantly reduced the incidence of recurrent strokes in a small group of high-risk patients with PFO and atrial septal aneurysm compared with antithrombotic drugs. Two-dimensional transoesophageal echocardiography (2D TEE) has become the election technique for guiding patent foramen ovale closure. Real-time Three-dimensional transoesophageal echocardiography (3D TEE) may be potentially superior to 2D TEE in the accurate assessment of the morphology and efficacy of transcatheter closure devices because of a better spacial orientation.
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PMID:Role of real-time three-dimensional transoesophageal echocardiography for guiding transcatheter patent foramen ovale closure. 1872 98


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