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PubMed2006

['Migraine and a hole in the heart': causal relationship between migraine and patent foramen ovale not established].

The relationship between patent foramen ovale (PFO) and migraine is controversial. A common genetic background seems possible, but there is no evidence for a causal relationship. Despite the lack of evidence, PFO closure is recommended in many countries as a remedy for migraine. At present, PFO closure for migraine should only be carried out under strictly controlled clinical trial conditions.

Genetic Predisposition to Disease↗

PubMed2006

Hypoplastic left heart syndrome with in utero closed foramen ovale: case report.

We report a case of a newborn with a prenatal diagnosis of hypoplastic left heart syndrome (HLHS), referred at 37 weeks of gestation. The fetal echocardiogram had shown classic morphologic aspects of HLHS with patent mitral valve and aortic valve atresia. The atrial septum was thickened and the foramen ovale (FO) appeared to be patent. It was a normal full-term delivery, with birth weight of 2540 g. Orotracheal intubation and mechanical ventilation were immediately necessary, as well as intravenous prostaglandin, due to clinical deterioration. Transthoracic echocardiography performed in the first hour of life confirmed the diagnosis, but doubts were raised about the patency of the FO. Cardiac catheterization was performed and Rashkind balloon atrial septostomy was attempted, without success. The baby died and pathologic examination revealed HLHS with intact atrial septum, dilated coronary sinus and pulmonary lymphangiectasia. In this case, the dilated coronary sinus led to a mistaken prenatal diagnosis of FO patency with left-to-right shunt.

Diagnostic Errors↗

PubMed1991

The frequency of patent foramen ovale in patients with ischemic stroke: a transesophageal echocardiographic study.

Transesophageal echocardiography has been described as superior to transthoracic echocardiography in the detection of patent foramen ovale (PFO). Utilizing both methods, we were able to determine the frequency of PFO in younger adult patients with ischemic stroke (patient group) and in age-matched control subjects (control group). Thirty-four patients under 55 years of age with cerebral or retinal ischemic attacks (mean age 39 years) and 40 controls (mean age 39 years) were studied. Transesophageal echocardiography detected a significantly higher frequency of PFO in the patient group (44%) than in the control group (18%, p less than 0.05). In comparison with transthoracic echocardiography, transesophageal echocardiography found a higher frequency of PFO in both the patient group (12% vs 44%, p less than 0.01) and the control group (3% vs 18%, p less than 0.05). All of the foramina proved to be patent by transthoracic echocardiography were also found by transesophageal echocardiography. The results suggest that transesophageal echocardiography is a sensitive method for demonstrating PFO. Paradoxical embolism through an interatrial communication (PFO) may be a possible cause of strokes in the young adult.

Adult↗

PubMed2006

Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale.

BACKGROUND: Transcatheter closure of patent foramen ovale (PFO) in patients with a history of cryptogenic stroke is performed with increasing frequency. However, the long-term effects of these closure devices on atrial tachyarrhythmias (ATs) are not known. METHODS AND RESULTS: The study population included 71 patients [31 (44%) men, aged 54 +/- 14 years] with PFO, diagnosed by transesophageal echocardiography (TEE), and greater than or equal to 1 cryptogenic stroke (n = 70) or orthodoxia (n = 1). Patients underwent transcatheter closure of PFO using a 28 mm (n = 53) or a 33 mm (n = 18) CardioSEAL closure device (n = 67) or an Amplatzer occluder (n = 4). Five (7%) patients presented with newly diagnosed (n = 4) or recurrent (n = 1) episodes of AT (3 atrial fibrillation and 2 typical atrial flutter) within 1 to 480 days following the procedure, with an average time to onset of 175 +/- 221 days. ATs were more frequent in those who received a 33 mm device than those who received a 28 mm device [4/18 (22%) vs. 1/53 (2%); p < 0.05]. Patients with ATs showed a trend toward a larger left atrium only on apical view (6.5 +/- 1.4 cm vs. 5.1 +/- 0.9 cm; p = 0.05). However, the difference in left atrial size on parasternal view and right atrial size between the 2 groups was not statistically significant (4.5 +/- 1.1 cm vs. 3.7 +/- 0.8 cm and 5.9 +/- 2.4 cm vs. 4.6 +/- 0.7 cm). Conclusion. Compared to the age-matched population, sustained ATs appear to be relatively common following transcatheter closure of PFO. In our series, they seemed to occur more frequently in patients who received larger devices.

Adult↗

PubMedDate not supplied

[Patent foramen ovale and migraine, a fortuitus association or a causal relationship?].

Epidemiologic studies have shown a clear comorbidity between migraine with aura and a patent foramen ovale (PFO). Under the age of 55, migraine with aura is a risk factor for ischemic stroke and a proportion of the latter is due to a PFO. It remains to be determined whether PFO is causally related to migraine attacks, or is a fortuitous association due to common genetic factors. Cortical spreading depression which is the underlying mechanism of the migrainous aura, could be favoured by a PFO. Several retrospective and uncontrolled studies suggest that percutaneous closure of a PFO for stroke or decompression illness in divers reduces frequency of migraine attacks with, but also without aura. Multicentric, prospective and controlled trials of this intervention in migraineurs are underway or in preparation. As long as their results are not known, there is no rationale for proposing PFO closure for migraine.

Adult↗

PubMed2006

[Echocardiography in patent foramen ovale].

Patent foramen ovale (PFO) is a flap-like opening between the primum and secundum atrial septum at the level of the fossa ovalis that may persist after birth. There is increasing evidence that PFO is the culprit in paradoxical embolic events in patients with ischemic stroke. Although medical or percutaneous treatment of PFO remains controversial, nowadays percutaneous treatment is widespread in clinical practice. Transesophageal echocardiography (TEE) is the gold standard in the diagnosis of PFO. This article describes how PFO is detected and how it needs to be properly described by echocardiography. PFO dimensions and the degree of right-to-left shunt should be measured. Moreover, septum primum and septum secundum characteristics, the association with an aneurysm of a fossa ovalis or with other atrial defects should be described as well as the presence of an atrial thrombus, a Chiari network or an Eustachian valve. Such information is of extreme value to predict embolic events and may influence further management.

Heart Septal Defects, Atrial↗

PubMed2006

Predictors and clinical outcomes of residual shunt in patients undergoing percutaneous transcatheter closure of patent foramen ovale.

OBJECTIVE: To determine echocardiographic characteristics that may identify patients likely to have residual right-to-left shunt after percutaneous closure of a patent foramen ovale (PFO). BACKGROUND: Characteristics of the atrial septum and PFO may identify patients who are likely to have residual shunt following percutaneous closure. METHODS: We reviewed 76 consecutive patients (42 women; 34 men) who underwent percutaneous PFO closure (AGA Amplatzer PFO occluder) for hypoxemia or paradoxical embolization who failed or were unable to receive systemic anticoagulation. Saline contrast echocardiography with and without the Valsalva maneuver was performed within 24 hours and after 6 months to assess for residual shunt. RESULTS: 48 patients (63%) had early closure of the PFO with total elimination of the shunt. Residual shunt was detected in 28 patients (37%), although the severity had diminished significantly compared to baseline. All patients with atrial septal aneurysm (n = 7), and all but 1 patient with a redundant atrial septum (n = 6) before percutaneous closure had residual shunts (p < 0.001). The patient's age, device size and PFO dimensions did not predict procedural success. At 6-month follow up, residual shunt had resolved in all but 3 patients. One of these 3 patients had a recurrent nonfatal transient ischemic event. CONCLUSIONS: A percutaneous transcatheter approach confers early closure of PFO and elimination of the shunt in a majority of patients. Residual shunts are seen in patients with a redundant atrial septum and atrial septum aneurysm in the early post-closure period, but resolve without major clinical sequelae by 6 months.

Adult↗

PubMed2006

[Patent foramen ovale. What is it and what does it indicate?].

Cryptogenic stroke accounts for up to 40 % of all ischemic strokes and is even more frequent in young patients. The patent foramen ovale (PFO) is found in almost 60% of these young patients and has been suggested as a potential cause of cryptogenic stroke in this age group. However, the pathological relevance of PFO in cryptogenic stroke and the most appropriate therapeutic handling of it have not been established. In this review, the current state of therapeutic handling and ongoing controversies are discussed and the most interesting results in this field, including recent metaanalyses, are presented.

Aged↗

PubMed2006

Stroke in congenital heart disease and patent foramen ovale.

Congenital heart disease is usually regarded as an esoteric field of medicine, dealt with primarily by dedicated specialists. However, over the last two decades, increased attention has been given by the medical profession, the media and the general public to the possible association between a minor and common congenital heart defect, namely patent foramen ovale, and stroke. In recent months, unusual and unfortunate circumstances have made this topic one of the most fiercely debated medical issues in Israel. It is the belief of the authors of this paper that the association of PFO and stroke can be better understood if the PFO is viewed as part of the broader context of congenital heart disease, and as such it will be presented. Paradoxical embolism is a mechanism of stroke unique to congenital heart disease. The direction and volume of shunted blood in various conditions have a central role in determining the risk of stroke, as will be explained. With this basic knowledge in mind, we shall critically assess the potential role of PFO in stroke patients, suggesting that each case be evaluated individually using the above-mentioned principles. Conditions that enhance the formation of clot or other embolic material will be discussed briefly. The review will conclude with the various treatment options and our center's own experience with this challenging topic.

Adult↗

PubMedDate not supplied

[Severe hypoxemia due to a right-left shunt at the level of the foramen ovale. A complication of right ventricular infarct].

A 76-year-old woman with an inferior wall myocardial infarction, with right ventricular involvement, developed severe arterial hypoxemia with neurological involvement. Pulmonary edema or embolism and chronic obstructive pulmonary disease were ruled-out, and a right-to-left shunt was demonstrated by contrast echocardiography at the level of the foramen ovale. After inotropic support and oxygen supplementation, the patient recovered, although with significant neurological sequelae. No focal lesions were detected in the central nervous system by computerized tomography. Hypoxemia improved, coinciding with the disappearance of right-to-left shunt by contrast echocardiography.

Aged↗

PubMedDate not supplied

[Synovial sarcoma of the oral cavity (foramen caecum) Report of a case and review of the literature].

The twelft case of synovial sarcoma of the neck originated in the base of the tongue at the foramen caecum is reported. The patient, a 21 year old man developed a 7 cm. tumor after a 5 month period. A radical neck disection revealed metastases to lymph nodes, to spinal chain and residual tumor infiltrating the parotid gland. The subsequent X-ray studies showed metastases to lung. The patient is well 1 year after surgery. The pathogenesis of synovial sarcomas in regions so distant from normal synovial elements as the neck and other sites is not clear. In the present case and in those reported previously it is probable that the arise from synovial cell lining tendon sheaths or adventitious bursae in the neck.

Adult↗

PubMed1991

[Otoneurologic manifestations of congenital abnormalities of foramen magnum region].

The symptoms and signs of 38 cases of congenital abnormalities of foramen magnum region have been analysed. Twenty-six cases presented dizziness and dysequilibrium, among them 16 had spontaneous nystagmus. ENG investigation was made systematically in four cases with spontaneous and gaze nystagmus. Ocular dysmetria, decreased intensity of optokinetic nystagmus, abnormal smooth pursuit movement and failure of fixation suppression were observed. Causes of the abnormalities were reviewed. The pathophysiological bases for the changes in ENG were briefly discussed.

Adolescent↗

PubMed1991

[Embolization of the foramen ovale in metastatic course of abdominal liposarcoma].

The authors report a case of embolization of the foramen ovale by a liposarcoma metastasis in a young woman of 28 years of age. Cardiac impact due to the progress of this rare tumor type remains unusual. The various clinical situations resulting from secondary cardiac locations are recalled. The diagnostic role of ultrasonography and the information which can be provided by nuclear magnetic resonance imaging in this context are also recalled.

Abdominal Neoplasms↗

PubMed1991

Radiographic evaluation of the corporotransverse ligament at the L5 intervertebral foramen: a cadaveric study.

An extraforaminal ligament bisecting the L5/S1 intervertebral foramen and known as the corporotransverse ligament was studied in 15 adult embalmed cadavers. Its relationship to the L5 ventral ramus, sympathetic chain and gray ramus communicans was observed and recorded. The corporotransverse ligament has been implicated as a site for potential entrapment of the L5 nerve. The purpose of this study was to determine if the ligament could be detected radiographically. A single sample spine containing the ligament was hemisected and the neural, vascular and adipose tissue removed. Plain film, linear tomography and axial computed tomography (CT) slices were evaluated and the results compared. The corporotransverse ligament was not visualized by either plain film or linear tomography. Due to its superior resolution in the imaging of soft tissues, the ligament was well demonstrated by CT. Further studies with the neural tissue intact, imaging with magnetic resonance and in vivo comparison studies are recommended.

Dissection↗

PubMed1990

[Paradoxal cerebral embolism: role of patent oval foramen].

A patent foramen ovale (PFO) is present in 25-35% of people at all ages of life and its size tends to increase with age. It is now possible to detect PFO's by contrast echocardiography and it has been shown that there exists quite frequently a spontaneous transient right-to-left shunt during systole and, moreover, a right-to-left shunt during Valsalva maneuver and coughing. Acute or chronic pulmonary hypertension are also causes of shunt. Besides, a highly statistical correlation has been found between PFO's and strokes of uncertain or absent cause. From 1984 to 1990 the authors have collected 29 cases with 47 embolic cerebral events. Twenty-five cases with 30 embolic cerebral events and a neurological report have been found in the literature from 1930 to 1986. The analysis of these 77 cerebral embolic events is presented. All ages and both sexes are equally affected. Several symptoms and signs can suggest the diagnosis: onset of the neurological disorders during an activity implying a Valsalva maneuver; onset during a recognized phlebitis of the legs of pelvis or, more often, in a clinical setting suggesting the possibility of phlebitis without overt symptoms and signs: post-partum, post-operative conditions with prolonged bed rest; concomitant pulmonary and cerebral embolism. In the authors series of 227 cerebral emboli, such paradoxical emboli account for 12.8% of the cases ant it is likely that the condition is still underdiagnosed.

Adult↗

PubMed1990

Some osseous and soft tissue causes of human intervertebral canal (foramen) stenosis.

Much attention has been paid to the causes of vertebral canal stenosis in humans but relatively little has been documented with regard to intervertebral canal (intervertebral "foramen," lateral spinal canal, nerve root canal) stenosis. As the dural sleeve ends at the outer opening of the intervertebral canal, a false "normal" myelogram is possible when a space occupying lesion occurs beyond the subarachnoid space. Also, if stenosis affects only vascular structures, compression of these structures cannot be noted during myelography, so venous stasis may be overlooked. Our cadaveric study investigates some causes of intervertebral canal stenosis due to encroachment by bony and soft tissue structures, and low magnification photomicrographs are used to illustrate some causes of stenosis.

Aged↗

PubMed1990

[A paradoxical air embolism in a closed foramen ovale].

This case report deals with a patient who was being operated on for a tumor of the colon and who died from a paradoxical venous air embolism. Accompanying massive blood loss impedes differentiation of hemodynamic disturbances either due to venous air embolism or to hemorrhage, respectively. Air was aspirated from the radial artery catheter that was used for blood-pressure monitoring and for taking blood samples for laboratory analysis. At autopsy, no probe-patent foramen ovale could be demonstrated. The mechanism of air passing from the venous to the systemic circulation in our patient remains speculative; however, mechanical cardiopulmonary reanimation itself with its underlying thoracic pump mechanism has to be considered as contributing to the transport of air from the venous to the arterial side of the circulation.

Anus Neoplasms↗

PubMed1990

[A case of two-chambered right ventricle complicating severe cyanosis due to tricuspid regurgitation and patent foramen ovale].

A 63-year-old female of two-chambered right ventricle (TCRV) associated with tricuspid regurgitation (TR), patent foramen ovale (PFO) and small ventricular septal defect (VSD) underwent corrective surgery successfully. She suffered severe heart failure and cyanosis with 47.7% of right-to-left shunt through PFO. The VSD was so small that no significant shunt was shown in catheterization data. Operative findings suggested that TR was caused by elongation of the chorda as a consequence of long-term pressure load of right ventricular inflow chamber. Among reported cases of TCRV, the present case is the oldest one who underwent corrective surgery successfully.

Female↗