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At least 1,135 records · Page 63Linked to original sources
PubMed2001

Haemodynamic quantification of different provocation manoeuvres by simultaneous measurement of right and left atrial pressure: implications for the echocardiographic detection of persistent foramen ovale.

AIMS: Persistent foramen ovale (PFO) is found in 9.2--32% of echocardiographic examinations. The gold standard for the detection of a PFO is transoesophageal echocardiography (TEE) and the mostly used provocation test is the Valsalva manoeuvre. The aim of our study was to evaluate the effectiveness of the Valsalva manoeuvre compared to other provocation tests by simultaneous haemodynamic measurements of the right and left atrial pressure. METHODS: Fifty patients underwent Swan-Ganz catheterization. Right atrial pressure and pulmonary capillary wedge pressure, which corresponds to the left atrial pressure, were measured simultaneously. The following manoeuvres were compared: the Valsalva manoeuvre, coughing, deep inspiration and expiration pressures of 20 mmHg, 40 mmHg and 60 mmHg. The main objective of our study was to compare the occurrence of pressure gradients (right atrial pressure> left atrial pressure). For further quantification mean gradients, time duration of pressure overlap, as well as products of mean gradients and overlap time were analysed. RESULTS: During the Valsalva manoeuvre a significant pressure gradient could be observed in 84% of the patients, followed by an expiration pressure of 60 mmHg (82%), inspiration (78%), expiration pressure of 40 mmHg (76%), coughing (75%) and an expiration pressure of 20 mmHg (62%). Comparing the mean gradients and the products of mean gradients and overlap time duration during the different manoeuvres, we could detect the significantly best results with the Valsalva manoeuvre. CONCLUSIONS: The Valsalva manoeuvre might be the most effective test to provoke a right-to-left atrial shunt for the detection of a PFO during echocardiographic examinations.

Adult↗
PubMed2004

Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography in adult cardiac surgical patients.

OBJECTIVE: To evaluate multiplane transesophageal echocardiography (TEE) for detection of patent foramen ovale (PFO) and to compare multiplane TEE with visual inspection (VI) for PFO detection. DESIGN: A prospective observational study. SETTING: University hospital (single institution). PARTICIPANTS: Patients presenting for cardiac surgery requiring TEE. INTERVENTIONS: Multiplane TEE including 2 atrial views with color-flow Doppler (CFD) and contrast echocardiography (CE) with a provocative respiratory maneuver (PRM) and comparison of multiplane TEE and VI with respect to PFO detection. MEASUREMENTS AND MAIN RESULTS: The cohort size was 187. PFO prevalence was 27.3%. CFD with serial decrease of the Nyquist limit detected 51% of all PFO: 41.2% in the bicaval view alone, 27.5% in the 4-chamber view alone, and 9.8% in both views. CE detected 78.4% of all PFO: 72.5% with PRM, 45.1% with no PRM, and 27.4% with/without PRM. PFO detection by multiplane TEE and visual inspection were correlated in 41 subjects. TEE diagnosed 11 PFO (26.8% prevalence, 3 missed by VI). VI diagnosed 12 PFO (29.3% prevalence, 4 missed by TEE). CONCLUSIONS: Multiplane TEE is a gold standard for detection of PFO. Despite advances in TEE technology, 2-dimensional imaging does not detect all PFO. To maximize PFO detection, multiple TEE modalities are required in multiple views, despite a low Nyquist limit for CFD or a PRM for CE. Even though multiplane TEE is equivalent to VI for PFO detection, the discrepancy rate may be an important consideration in the individual case.

Cardiac Surgical Procedures↗
PubMed2005

Analysis of the interatrial septum by transesophageal echocardiography in adult cardiac surgical patients: anatomic variants and correlation with patent foramen ovale.

OBJECTIVES: The purpose of this study was to document the perioperative prevalence of anatomic variants of the interatrial septum (IAS), to classify atrial septal aneurysm based on mobility pattern, and to correlate anatomic variants of IAS with patent foramen ovale (PFO). DESIGN: A prospective observational study. SETTING: University hospital (single institution). PARTICIPANTS: Patients presenting for cardiac surgery requiring transesophageal echocardiography. INTERVENTIONS: Multiplane TEE in 2 atrial views with color-flow Doppler and contrast echocardiography with a provocative respiratory maneuver. MEASUREMENTS AND MAIN RESULTS: The cohort size was 206. PFO prevalence was 30.1%. The prevalence of IAS lipomatous hypertrophy was 43.2%, atrial septal flap (ASF) 43.2%, and atrial septal aneurysm (ASA) 28.6%. ASF and ASA were significantly ( p < 0.05) associated with PFO. Selected ASA subtypes are significantly associated with PFO ( p < 0.05). CONCLUSIONS: IAS anatomic variants are common in adult cardiac surgical patients undergoing multiplane TEE. The presence of ASF and ASA predicts enhanced PFO detection. ASA mobility patterns significantly correlate ( p < 0.05) with the presence of PFO.

Adolescent↗
PubMed2005

National survey regarding the management of an intraoperatively diagnosed patent foramen ovale during coronary artery bypass graft surgery.

OBJECTIVE: With the increased use of intraoperative transesophageal echocardiography (TEE), patent foramen ovale (PFO) has become a common finding during routine coronary artery bypass graft (CABG) surgery. This survey was designed to study potential differences in the management of intraoperatively diagnosed PFO. DESIGN: A written survey. SETTING: US university and community hospitals. PARTICIPANTS: The authors randomly selected 50% of US cardiac surgeons listed in the Cardiothoracic Surgery Network Database (n = 734). INTERVENTIONS: A written survey was mailed to the participants. The survey questions included respondents' use of TEE during CABG surgery, examination for a PFO with TEE, and management of intraoperatively diagnosed PFO in the CABG surgery. MEASUREMENTS AND MAIN RESULTS: Overall, 64% of individuals (468/734) responded to the survey request. TEE is available in the primary institution of 98.6% of respondents and used to search for a PFO in approximately one third of all CABG surgeries. During planned on-pump CABG surgery, 27.9% of respondents always close an intraoperatively diagnosed PFO, whereas 10.2% of respondents never close an intraoperatively diagnosed PFO. During planned off-pump CABG surgery, 27.6% of surgeons never change their plan, and 11% of respondents always convert the procedure to on-pump CABG to close the PFO. The majority of respondents decide whether to close a PFO based on the size of the PFO, the right atrial pressure, and a history of possible paradoxical embolism. CONCLUSIONS: In the United States, TEE is used extensively during CABG surgery. There is significant variability in how intraoperatively diagnosed PFO is managed during CABG surgery.

Blood Pressure↗
PubMed2002

Morphologic basis for the intraoral vertical ramus osteotomy: anatomic and radiographic localization of the mandibular foramen.

PURPOSE: The study goals were to provide anatomic and radiographic parameters that permit the performance of an intraoral vertical ramus osteotomy (IVRO) without violation of the mandibular foramen (Fm) and to evaluate the usefulness of the LeVasseur-Merrill retractor (Walter Lorenz Surgical, Jacksonville, FL) developed for IVRO. MATERIALS AND METHODS: Two hundred eighty dry adult human mandibular rami were measured, directly and via panoramic radiography, to obtain the horizontal and vertical positions of the Fm in the mandibular ramus. Measurements of the dry mandible were also compared with the radiographs to estimate Fm location. RESULTS: The Fm is located approximately at the posterior third of the ramus, in both the vertical and horizontal directions. The Fm was located within 7 mm of the posterior edge of the mandible in only 3.3% of the rami. Radiographic distortion of the total length of the ramus was an average of only 0.9%. The LeVasseur-Merrill retractor was effective in 98.9% of the analyzed rami. CONCLUSIONS: Estimation of the Fm position during surgery on the posterior edge of the ramus is useful. Measurement of the ramus width, performed with preoperative panoramic radiography, effectively locates the Fm. The LeVasseur-Merrill retractor, when correctly positioned, was an effective tool in determining the appropriate thickness of the IVRO proximal fragment.

Adult↗
PubMed2002

Mandibular nerve block at the oval foramen using reliable landmarks: refinement of a previously described procedure.

The aim of this study was to improve the injection technique when blocking the mandibular nerve at the oval foramen by using consistent landmarks. The lower lateral orbital angle (LLOA) and the junction of the external acoustic canal and the mastoid process (AM) proved to be reliable landmarks. Distances between landmarks for the localization of the puncture point (PP), cranial indices as well as the angle of the injection needle to the sagittal plane were calculated on 22 human dried skulls. The PP was found to lie exactly in the middle between the LLOA and AM. The angle of the injection needle to the sagittal plane was 71.86 degrees. No correlation was found between the cranial index and the angulation of the needle or the distances for the localization of the PP. From this study a modified puncture technique was developed.

Anesthesia, Dental↗
PubMed2002

Tumours around the foramen of Monro: clinical and neuroimaging features and their differential diagnosis.

The clinical and neuroimaging features of 20 patients with lateral ventricular tumours located around the foramen of Monro were reviewed retrospectively with special emphasis on the differential diagnoses. Histologic types were: eight neurocytomas, four subependymal giant cell astrocytomas (SGCAs), three subependymomas, two fibrillary astrocytomas, and one each of pilocytic astrocytoma, malignant astrocytoma and malignant teratoma. The mean age of the patients with neurocytoma was 29.6 years, with SGCA 13.3 years and with subependymoma 55.3 years. All tumours appeared nodular in shape, and on computed tomography (CT) neurocytomas were either isodense or highdense with the brain, while all subependymomas and SGCAs were lowdense. Calcification was observed in two SGCAs, and one neurocytoma. Five neurocytomas and all four SGCAs showed mild to moderate contrast enhancement, while all three subependymomas showed either no, or scarce, enhancement. Magnetic resonance imaging (MRI) studies were available in 10 patients, with the signal characteristics of four neurocytomas and three SGCAs being nonspecific, while two subependymomas were both hypointense on T1-weighted images and hyperintense on T2-weighted images. Thus important features for differential diagnosis included age of the patient and density on precontrast CT. In this series, either an extensive excision of the tumour or a partial removal, thus relieving the obstruction of the foramina of Monro, usually provided long term survival, with 18 patients surviving a mean of 10.8 years.

Adolescent↗
PubMed2001

Surgical tactics and outcome of treatment in jugular foramen schwannomas.

Seven patients with schwannomas of the jugular foramen were included our study in Samsung Medical Center between 1995 and 1999. Patients with neurofibromatosis were excluded. The records of the seven patients (six surgical case and one nonsurgical case) were retrospectively reviewed. There were six women and one man (mean age, 47 years) with a symptom duration ranging from 3 months to 14 years (mean, 47 months). The predominant symptoms were hearing difficulty, hemifacial spasm and hoarseness. Preoperative audiologic evaluation, computerised tomography (CT), magnetic resonance (MR) imaging, and angiography were performed in most patients. We classified tumours into four types using Kaye and Pellet classification on the basis of radiological and surgical findings. The tumours were: Type A (at cerebellopontine angle) in one; Type B (foraminal) in two; Type C (extracranial and/or foraminal) in two; and Type D (intra- and extracranial) in two cases. We used various surgical approaches such as retrosigmoid suboccipital craniectomy for Type A tumours, infratemporal fossa type A approach (ITFA) for Type C tumours, petro-occipital transsigmoid approach or modified transcochear approach for Type D tumours and ITFA with partial labyrinthectomy for Type B. In the selection of surgical approaches, we took consideration of tumour extension, tumour size, and preoperative hearing function. Facial nerve transposition was not used only in one case of ITFA because of small tumour size (1.5cm). Gross total removal was achieved in five cases, and subtotal removal in one case (Type D tumour) with a single-stage operation. Stereotactic radiosurgery was performed on residual mass in the subtotally removed case. Follow-up period ranged from 13 to 49 months (mean, 27.5 months). There was neither postoperative mortality nor recurrence on follow-up MR imaging. There were two cases of temporary facial nerve palsy and one aggravation of pre-existing low cranial palsy. Two case of sustained vocal cord palsy underwent thyroplasty, but there was no aspiration pneumonia. Persistent cerebrospinal fluid collection was improved with lumboperitoneal shunt. The surgical approaches of each case should be tailored according to their shape and the clinical manifestation. We obtain acceptable outcomes from one-stage operation.

Accessory Nerve↗
PubMed2001

[Simultaneous transthoracic echocardiography and transcranial doppler ultrasonography with ultrasound contrast agents for the detection of a patent foramen ovale in diving medicine].

OBJECTIVE: Presentation of a non-invasive method for the identification of a patent foramen ovale (PFO) in screening of diving-candidates or for the investigation of diving accidents. METHOD: Simultaneous transthoracic echocardiography and transcranial Doppler sonography of the middle cerebral artery using ultrasound contrast media. RESULTS: In an unselected collective of amateur and professional divers a PFO was identified according to statistical prediction. CONCLUSION: This method can be used in diving medicine for PFO detection as an alternative procedure to transesophageal echocardiography.

Adult↗
PubMed2002

Neuroendoscopic third ventriculostomy in a patient with occluded foramen of Monro: a case report.

We treated recurrent hydrocephalus in a previously shunted patient by neuroendoscopic third ventriculostomy. A tear was noted in the septum pellucidum. As the foramen of Monro was found to be occluded, we first fenestrated the floor of the lateral ventricle and then performed third ventriculostomy through the fenestration. A tough membrane believed to be Liliequist's membrane isolated the space immediately beneath floor of the third ventricle from the cistern below. Cerebrospinal fluid pulsation appeared after fenestration of this membrane. These obstructions presumably resulted from congenital and/or inflammatory causes. In cases such as this, successful neuroendoscopic third ventriculostomy presents a challenge to surgical judgment.

Adolescent↗
PubMed2004

[Interventional catheter closure of persistent foramen ovale (PFO) in a patient with paradoxical embolism and Brugada's syndrome].

HISTORY AND ADMISSION FINDINGS: A 41-year-man was admitted because of acute bluish-grey skin discoloration in cold sensation in the right hand. His brother had suffered sudden cardiac death, aged 42 years. INVESTIGATIONS: Angiography demonstrated embolic occlusion of the digital artery of the right thumb. Transesophageal echocardiography showed a persistent foramen ovale (PFO) with an aneurysm of the atrial septum (ASA) with marked right-to-left shunt of contrast medium during a Valsalva maneuvre as well as two smaller septal fenestrations. There was no evidence of any other source of embolism. The resting electrocardiogram showed an incomplete right bundle branch block with ST elevations in V (1)-V (3), changes like those described in Brugada's syndrome. TREATMENT AND COURSE: Paradoxical embolism having been demonstrated, the PFO with ASA were closed with a percutaneously introduced Helex septum occluder. Later an implantable cardioverter-defibrillator (ICD) was introduced. CONCLUSIONS: A PFO, particularly if associated with an atrial aneurysm, is an important site of paradoxical embolism. In symptomatic patients percutaneous transcatheter septal occlusion should be considered preceding any ICD insertion thought necessary for concurrent Brugada's syndrome.

Adult↗
PubMed2006

Unilateral hydrocephalus due to foramen of monro stenosis.

Unilateral lateral ventricular dilatation due to foramen of Monro stenosis or constriction can present with headache. Fundoscopy can be normal. This condition is congenital, radiological appraisal can disclose the diagnosis, and treatment depends upon the symptomatology. The condition can be treated well with insertion of a ventriculoperitoneal shunt.

Adolescent↗
PubMed2005

Patent foramen ovale and stroke risk: incidental finding or causal culprit?

Between 17 and 27% of the population has a patent foramen ovale (PFO) based on autopsy studies. Given these percentages, a PFO could be considered a variant of normal cardiac anatomy and not an anomaly. As this anatomy is so prevalent in the normal population, it is likely that there are other factors involved in patients who have a PFO and a stroke. This review will evaluate the existing literature on PFO and stroke to determine what constitutes an increased risk of embolic events in patients with PFO. Given the paucity of existing literature, it is clear from this review that there is a vital need for randomized clinical trials to answer important questions, including what constitutes high-risk anatomy and optimal treatment for patients for the prevention of recurrent stroke.

Age Factors↗
PubMed2006

Cryptogenic stroke in children: possible role of patent foramen ovale.

Stroke is a rare disorder in childhood. The majority of these cases is of an ischemic nature. In spite of the long list of known causes, many strokes remain undetermined, so-called cryptogenic strokes. Increasing evidence indicates that, in the young adults, many cases of cryptogenic stroke are presumably due to paradoxical embolism. In childhood, this is usually not considered, unless in the context of a complex cyanotic heart disease. We present two cases, a 6-year-old boy and an 11-year-old girl who had an episode of cerebral ischemia documented by MRI, and in whom the only anomaly found was a patent foramen ovale (PFO) with intermittent left to right shunt at rest, but with a large right to left shunt during the Valsalva maneuvre. We assumed that, in our cases, in the absence of identifiable causes, the cerebral ischemia was most likely due to paradoxical embolism through the PFO. Of course, as in the adult, the paradoxical embolism could not be proved, but in our opinion it remains the most concrete possibility. Therefore, in presence of a cryptogenic stroke, a PFO should be investigated also in children.

Child↗
PubMed2006

[MRI safety aspects and artifacts of atrial septal defect and patent foramen ovale occluders at 1.5 tesla: a phantom study].

PURPOSE: To investigate the magnetic resonance safety and magnetic resonance artifact intensities of patent foramen ovale and atrial septal occluders in a phantom study. MATERIALS AND METHODS: Seven different commercial occluder models (Amplatzer ASD, Angel Wing ASD, Helex Septal Occluder, Cardia PFO-Star Generation I & III, Sideris Buttoned Device, Starflex ASD) were tested in a 1.5 Tesla whole-body MR scanner. Following a deflection test, the non-magnetic devices were imaged using different MRI pulse sequences including conventional spin echo, spoiled gradient echo as well as fast refocused steady-state pulse sequences (trueFISP) commonly used for cardiac MRI. Additionally, device temperatures were measured in the MR scanner during two imaging protocols (trueFISP, HASTE) with an MR-compatible fiber-optical thermometer. RESULTS: One ferromagnetic device (Sideris Buttoned Device) did not pass the deflection test and was excluded from further experiments. For typical cardiac imaging protocols, the remaining non-ferromagnetic devices showed only minor image artifacts with artifact sizes not exceeding 2 mm next to a strut. Heating was not observed in the devices. CONCLUSION: Non-ferromagnetic occluder models used in this study can safely be imaged with typical cardiac MRI protocols at 1.5 Tesla. The device artifact sizes are small enough to allow anatomical and functional MRI even in the immediate vicinity of the occluders.

Artifacts↗
PubMed1998

[Misplacement of a transvenous lead from an implantable cardioverter-defibrillator into the left ventricle via a patent foramen ovale].

HISTORY AND CLINICAL FINDINGS: 24-hour ECG monitoring in a 64-year-old man revealed self-limited (< 30 s) ventricular tachycardias (VT) of > 200/min. He had triple-vessel coronary artery disease with both anterior and posterior wall infarctions treated by three aortocoronary venous grafts. Physical examination was unremarkable except for a well healed thoracotomy scar. INVESTIGATIONS: Programmed ventricular stimulation induced prolonged monomorphic VT of 320 beats/min, despite aminodarone treatment. Left-heart catheterization demonstrated the three patent aortocoronary grafts and a left-ventricular ejection fraction of only 20%. TREATMENT AND COURSE: Because of the inducible and prolonged VT, despite antiarrhythmic treatment with amiodarone, a cardioverter-defibrillator was implanted (ICD). During threshold measurements of the pacemaker integrated into the ICD the pacemaker impulse was noted to produce a right bundle branch block pattern, the ICD lead having erroneously been placed in the left ventricle via a patent foramen ovale. The lead was left in place, because the ICD was functioning well and lead removal with the possible need of a thoracotomy carried a high risk. CONCLUSION: Extreme caution is needed to avoid malpositioning an implantable cardioverter-defibrillator. If the lead tip is unwittingly fixed in the left ventricle but functions well it should be left in place under prophylactic anticoagulation, because of the potentially high risk of its operative removal.

Amiodarone↗
PubMed1991

[Functional deficits of caudal cranial nerves after surgery of tumors in the foramen jugulare. A long-term follow-up study].

Jugular foramen tumors involve a critical area of the skull base. Usually they are characterized by palsy of the ninth, tenth, and eleventh cranial nerves. Depending on the extent of the tumor there are various approaches to the skull base and various surgical strategies to preserve the cranial nerves. The study is based on 31 patients who were operated on between 1982 and 1989 at the University ENT and Neurosurgery Departments in Freiburg and Mainz. The neurological findings were analyzed on admission, on discharge, and in the follow-up. While there was partial or complete dysfunction of the lower cranial nerves on discharge, long-term compensation was excellent. All patients were able to breath normally and maintain their weight by oral diet. Rerouting of the facial nerve endangers its postoperative function. Nevertheless, the long-term follow-up demonstrated excellent recovery and good functional and cosmetic results.

Adolescent↗