Interv Akut Kardiol. 2008;7(1):24-29

Paradoxical embolisation - diagnosis and treatment patent foramen ovale

Jaroslav Januška
Kardiocentrum Nemocnice Podlesí, Třinec

Paradoxical embolisation of thrombi, gas bubbles and also vasoactive substancies is possible due to foramen ovale patens (PFO). Right to left shunt formation supports arterial blood desaturation in certain diseases. Article is describing diseases related to PFO. We are showing indications and interventional approach to PFO closure.

Keywords: foramen ovale patens, atrial septal aneurysm, catheterisation closure, paradoxical embolisation, CVA

Published: March 27, 2008  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Januška J. Paradoxical embolisation - diagnosis and treatment patent foramen ovale. Interv Akut Kardiol. 2008;7(1):24-29.
Download citation

References

  1. Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984; 59: 17-20. Go to original source... Go to PubMed...
  2. Yahia AM, Shaukat A, Kirmani JF, Qureshi AI. Age is not a predictor of patent foramen ovale with right-to-left shunt in patients with cerebral ischemic events. Echocardiography. 2004; 21: 517-522. Go to original source... Go to PubMed...
  3. Hargreaves M, Maloney D, Gribbin B, Westaby S. Impending paradoxical embolism: a case report and literature review. Eur Heart J. 1994; 15: 1284-1285. Go to original source... Go to PubMed...
  4. Clarke NR, Timperley J, Kelion AD, Banning AP. Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts. Eur J Echocardiogr. 2004; 5: 176-181. Go to original source... Go to PubMed...
  5. Blum A, Reisner S, Farbstein Y. Transesophageal echocardiography (TEE) vs. transthoracic echocardiography (TTE) in assessing cardio-vascular sources of emboli in patients with acute ischemic stroke. Med Sci Monit. 2004; 10: CR521-523.
  6. Schuchlenz HW, Weihs W, Horner S, Quehenberger F. The Association between the Diameter of a Patent Foramen Ovale and the Risk of Embolic Cerebrovascular Events Am J Med. 2000; 109: 456-462. Go to original source... Go to PubMed...
  7. Cabanes L, Coste J, Derumeaux G, Jeanrenaud X, Lamy C, Zuber M, Mas JL; Patent Foramen Ovale and Atrial Septal Aneurysm Study Group. Interobserver and intraobserver variability in detection of patent foramen ovale and atrial septal aneurysm with transesophageal echocardiography. J Am Soc Echocardiogr. 2002 May; 15: 441-446. Go to original source... Go to PubMed...
  8. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study. Brain 2005; 128: 2068-2077. Go to original source... Go to PubMed...
  9. Buttignoni SC, Khorsand A, Mundigler G, Bergler-Klein J, Heger M, Zehetgruber M, Baumgartner H, Binder T. Agitated saline versus polygelatine for the echocardiographic assessment of patent foramen ovale. J Am Soc Echocardiogr. 2004 Oct; 17: 1059-1065. Go to original source... Go to PubMed...
  10. Daniels C, Weytjens C, Cosyns B, et al. Second harmonic transthoracic echocardiography: the new reference screening metod for the detection of patent foramen ovale. Eur J Echocardiography 2004; 5: 449-452. Go to original source... Go to PubMed...
  11. Teague SM, Sharma MK. Detection of paradoxical cerebral echo contrast embolization by transcranial Doppler ultrasound. Stroke. 1991; 22: 740-745. Go to original source... Go to PubMed...
  12. Chimowitz MI, Nemec JJ, Marwick TH, Lorin RJ, Furlan AJ, Salcedo EE. Transcranial Doppler ultrasound identifies patients with right-to-left cardiac or pulmonary shunts. Neurology. 1991; 41: 1902-1904. Go to original source... Go to PubMed...
  13. Di Tullio M, Sacco RL, Venketasubramanian N, Sherman D, Mohr JP, Homma S. Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke. 1993; 24: 1020-1024. Go to original source... Go to PubMed...
  14. Blersch WK, Draganski BM, Holmer SR, et al. Transcranial duplex sonography in detection of patent foramen ovale. Radiology 2002; 225: 693-699. Go to original source... Go to PubMed...
  15. Saqqur M, Dean N, Schebel M, et al. Improved detection of microbubble signal using Power M-mode doppler. Stroke 2004; 35: e14-e17. Go to original source... Go to PubMed...
  16. Eggebrecht H, Naber CK, Plato C, Erbel R, Bartel T. Analysis of fossa ovalis membrane velocities by transesophageal Doppler tissue echocardiography: a novel approach to functional assessment of patent foramen ovale. J Am Soc Echocardiogr. 2004; 17: 1161-1166. Go to original source... Go to PubMed...
  17. Cabanes L, Mas JL, Cohen A, Amarenco P, Cabanes PA, Oubary P, Chedru F, Guerin F, Bousser MG, de Recondo J. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography. Stroke. 1993 Dec; 24: 1865-1873. Go to original source... Go to PubMed...
  18. Mügge A, Daniel WG, Angermann Ch, Spes Ch, Khandheria BK, Kronzon I, Freedberg RS, Keren A, Dennig K, Engberding R, Sutherland GR, Vered Z, Erbel R, Visser CA, Lindert O, Hausmann D, Wenzlaff P. Atrial Septal Aneurysm in Adult Patients. Circulation. 1995; 91: 2785-2792. Go to original source... Go to PubMed...
  19. De Castro S, Cartoni D, Fiorelli M, Rasura N, Anzini A, Zanette EM, Beccia M, Colonnese C, Fedele F, Fieschi C, Pandian NG, Morphological and Functional Characteristics of Patent Foramen Ovale and Their Embolic Implications. Stroke. 2000; 31: 2407. Go to original source... Go to PubMed...
  20. Hanley PC, Tajik AJ, Hynes JK, et al. Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol. 1985; 6: 1370-1382. Go to original source... Go to PubMed...
  21. Lechat P, Mas JL, Lascault G, Loron P, Theard M, Klimczac M, Drobinski G, Thomas D, Grosgogeat Y. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988; 318: 1148-1152. Go to original source... Go to PubMed...
  22. Mas J-L, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, Coste J for the Patent Foramen Ovale and Atrial Septal Aneurysm Study Group. Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both. NEJM 2001; 345: 1740-1746. Go to original source... Go to PubMed...
  23. Agmon Y, Khandheria BK, Meissner I, Gentile F, Whisnant JP, Sicks JD, O'Fallon WM, Covalt JL, Wiebers DO, Seward JB. Frequency of Atrial Septal Aneurysms in Patients With Cerebral Ischemic Events Circulation. 1999; 99: 1942-1944. Go to original source... Go to PubMed...
  24. Cerrato P, Grasso M, Imperiale D, Priano L, Baima C, Giraudo M, Rizzuto A, Azzaro C, Lentini A, Bergamasco B. Stroke in young patients: etiopathogenesis and risk factors in different age classes. Cerebrovasc Dis. 2004; 18: 154-159. Go to original source... Go to PubMed...
  25. Meier B. Patent foramen ovale, guilty but only as a gang member and for a lesse crime. J Am Coll Cardiol 2006; 47: 446-448. Go to original source... Go to PubMed...
  26. Homma S, DiTullio MR, Sacco RL, Sciacca RR, Mohr JP; PICSS Investigators. Age as a determinant of adverse events in medically treated cryptogenic stroke patients with patent foramen ovale. Stroke. 2004; 35: 2145-2159. Epub 2004 Jul 01. Go to original source... Go to PubMed...
  27. Anderson FA Jr, Wheeler HB, Goldberg RJ et al. A population/based perspective of the hospital incidence and case/fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study. Arch Intern Med 1991; 151: 933-985. Go to original source...
  28. Hagen PT, Scholz DG, Edwards JP et al. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984; 59: 17-20. Go to original source... Go to PubMed...
  29. Fukumoto A, Yaku H, Doi K et al. Continuous Trombus in the Right and Left Atria Penetrating the Patent Foramen Ovalis. Circulation 2005; 112: e143-e144. Go to original source... Go to PubMed...
  30. Giardini A, Donti A, Formigari R, Bronzetti G, Prandstraller D, Bonvicini M, Palareti G, Guidetti D, Gaddi O, Picchio FM. Comparison of results of percutaneous closure of patent foramen ovale for paradoxical embolism in patients with versus without thrombophilia. Am J Cardiol. 2004; 94: 1012-1016. Go to original source... Go to PubMed...
  31. Germonpré P, Dendale P, Unger P, Balestra C. Patent foramen ovale and decompression sickness in sports divers. J Appl Physiol 1998; 84: 1622-1626. Go to original source... Go to PubMed...
  32. Germonpré P, Hastir F, Dendale P, Marroni A, Nguyen AF, Balestra C. Evidence for increasing patency of the foramen ovale in divers. AJC 2005; 95: 912-915. Go to original source... Go to PubMed...
  33. Walsh KP, Wilmshurst PT, Morrison WL. Transcatheter closure of patent foramen ovale using the Amplatzer septal occluder to prevent recurrence of neurological decompression illness in divers Heart 1999; 81: 257-261. Go to original source... Go to PubMed...
  34. Cartoni D, De Castro S, Valente G, Costanzo C, Pelliccia A, Beni S, Di Angelantonio E, Papetti F, Vitali Serdoz L, Fedele F. Identification of professional scuba divers with patent foramen ovale at risk for decompression illness. Am J Cardiol. 2004; 94: 270-273. Go to original source... Go to PubMed...
  35. Torti SR, Billinger M, Schwerzmann M, Vogel R, Zbinden R, Windecker S, Seiler C. Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale. Eur Heart J. 2004; 25: 1014-1020. Go to original source... Go to PubMed...
  36. Koch AE, Kampen J, Tetzlaff K, Reuter M, McCormack P, Schnoor PW, Struck N, Heine L, Prytulla I, Rieckert H. Incidence of abnormal cerebral findings in the MRI of clinically healthy divers: role of a patent foramen ovale. Undersea Hyperb Med. 2004; 31: 261-268.
  37. Honěk T, Veselka J, Tomek A et al. Foramen ovale patens jako příčina paradoxní embolizace u sportovních potápěčů. Cor Vasa 2006; 48: 286-288.
  38. Azarbal B, Tobis J, Suh W et al. Association of interatrial shunts and migraine headaches. JACC 2005; 45: 489-492. Go to original source... Go to PubMed...
  39. Wilmshurst PT, Pearson MJ, Nightingale S, Walsh KP, Morrison WL. Inheritance of persistent foramen ovale and atrial septal defects and the relation to familial migraine with aura. Heart. 2004; 90: 1315-1320. Go to original source... Go to PubMed...
  40. Domitrz I, Mieszkowski J, Kwiecinski H. The prevalence of patent foramen ovale in patients with migraine Neurol Neurochir Pol. 2004; 38: 89-92. Go to PubMed...
  41. Schwerzmann M, Wiher S, Nedeltchev K, Mattle HP, Wahl A, Seiler C, Meier B, Windecker S. Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks. Neurology. 2004; 62: 1399-1401. Go to original source... Go to PubMed...
  42. Kruit MC, van Buchem MA, Hofman PA et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004; 291: 427-434. Go to original source... Go to PubMed...
  43. Reif M. Foramen ovale patens v neurologii. Neurol. pro praxi, 2007; 3: 175-178.
  44. Pemberton J, Irvine T, Stewart MJ, Antunes G, Gibson GJ. Platypnoea orthodeoxya in a patient with aortic root dilatation and patent foramen ovale. Eur J Echocardiography 2007; 8: 151-154. Go to original source... Go to PubMed...
  45. Mansencal N, Mitry E, Forisser JF et al. Assessment of patent foramen ovale in carcinoid heart disease. Am Heart J 2006; 151: 1129. e1-6. Go to original source... Go to PubMed...
  46. Hacievlivagil SS, Gunen H, Kosar FM, Sahin I, Kilic T. Prevalence and clinicl signifikance of a patent foramen ovale in patiens with chronic obstructive pulmonary disease. Respir Medicine 2006; 100: 903-910. Go to original source... Go to PubMed...
  47. Molenat F, Boussuges A, Operation Everest III (Comex´97): Altitude-induced decompression sickness during a hypobaric chamber experiment. Chest 2002; 121: 173-177. Go to original source... Go to PubMed...
  48. Shanoudy, Soliman A, Raggi, Liu JW, Russel DC, Jarmukli NF. Prevalence of patent foramen ovale and its contribution to hypoxemia in patients with obstructive sleep apnea. Chest 1998; 113: 91-96. Go to original source... Go to PubMed...
  49. Beelke M, Angeli S, Del Sette M et al. Prevalence of patent foramen ovale in subjects with obstructive sleep apnea: a transcranial Doppler ultrasound study. Sleep Med 2003; 4: 219-223. Go to original source... Go to PubMed...
  50. Agnoletti G, Iserin L, Lafont A, Sidi D, Desnos M. Obstructive sleep apnoea and patent foramen ovale succeful treatment of symptoms by percutaneous foramen ovale closure. J Interv Cardiol 2005; 18: 393-395. Go to original source... Go to PubMed...
  51. Windecker S, Wahl A, Nedeltchev K, Arnold M, Schwerzmann M, Seiler C, Mattle HP, Meier B. Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke. J Am Coll Cardiol. 2004; 44: 759-761. Go to original source... Go to PubMed...
  52. Stone DA, Godard J, Corretti MC et al. Patent foramen ovale: Asssociation between the degree of shunt by contrast transesophageal echocardiography and the risk of future ischemic neurologic events. Am Heart J 1996; 131: 158-160. Go to original source... Go to PubMed...
  53. Homma S, Di Tullio MR, Sacco RL, Sciacca RR, Smith C, Mohr JP. Surgical Closure of Patent Foramen Ovale in Cryptogenic Stroke Patients Stroke. 1997; 28: 2376-2381. Go to original source... Go to PubMed...
  54. Dearani JA, Ugurlu BS, Danielson GK et al. Surgical patent foramen ovale closure for preventiv of paradoxical embolism-related cerebrovascular ishemic events. Circulation 1999; 100: II-171-175. Go to original source... Go to PubMed...
  55. Alameddine F, Block PC. Transcatheter patent foramen ovale closure for secondary prevention of paradoxical embolic events: Acute results from the FORECAST registry. Catheter Cardiovasc Interv. 2004; 62: 512-516. Go to original source... Go to PubMed...
  56. Masura J, Gavora P, Formanek A, Hijazi ZM. Transcatheter closure of secundum atrial septal defects using the new self-centering amplatzer septal occluder: initial human experience. Cathet Cardiovasc Diagn. 1997; 42: 388-393. Go to original source... Go to PubMed...
  57. Braun MU, Fassbender D, Schoen SP et al. Transcatheter Closure of Patent Foramen Ovale in Patients With Cerebral Ischemia J Am Coll Cardiol. 2002; 39: 2019-2025. Go to original source... Go to PubMed...
  58. Purcell IF, Brecker SJ, Ward DE. Closure of defects of the atrial septum in adults using the Amplatzer device: 100 consecutive patients in a single center. Clin Cardiol. 2004; 27: 509-513. Go to original source... Go to PubMed...
  59. Ferrari J, Baumgartner H, Tentschert S, Dorda V, Lang W, Willfort-Ehringer A, Probst P, Lalouschek W. Cerebral microembolism during transcatheter closure of patent foramen ovale. J Neurol. 2004; 251: 825-829. Go to original source... Go to PubMed...
  60. Anzola GP, Morandi E, Casilli F, Onorato E. Does transcatheter closure of patent foramen ovale really, ,shut the door?" A prospective study with transcranial Doppler. Stroke. 2004; 35: 2140-2144. Epub 2004 Jul 29. Go to original source... Go to PubMed...
  61. Demkow M, Ruzyllo W, Kepka C, Pruszczyk P, Opuchlik A, Szyluk B, Konka M, Wilczynski J, Szulc M, Kwiecinski H. Transcatheter closure of patent foramen ovale in patients with cryptogenic stroke. Kardiol Pol. 2004; 61: 101-109; discussion 109. Go to PubMed...
  62. Wahl A, Meier B, Haxel B et al. Prognosis after percutaneous closure of patent foramen ovale for paradoxical embolism. Neurology 2001; 57: 1330-1332. Go to original source... Go to PubMed...
  63. Varma C, Benson LN, Warr MR, Yeo E, Yip J, Jaigobin CS, Webb G, McLaughlin PR. Clinical outcomes of patent foramen ovale closure for paradoxical emboli without echocardiographic guidance. Catheter Cardiovasc Interv. 2004; 62: 519-525. Go to original source... Go to PubMed...
  64. Salome N, Braga P, Goncalves M, Rodrigues A, Ribeiro J, Fonesca C, Pinto F, Ribeiro VG. Transcatheter device occlusion of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance. Rev Port Cardiol. 2004; 23: 709-717. Go to PubMed...
  65. Homma S, Sacco PL, Di Tullio MR et al. Effect of medical treatment in stroke patients with patent foramen ovale. Circulation. 2002; 105: 2625-2631. Go to original source... Go to PubMed...
  66. Kennedy J, Buchan AM. Ever Decreasing Circles: Advances in Antiplatelet Therapy and Anticoagulation Stroke. 2003; 34: 348.
  67. Vojáček J, Mates M, Popelová J, Mašura J. Katetrizační uzávěr defektu septa síní typu secundum a otevřeného foramen ovale u dospělých - naše první zkušenosti. Supplementum Cor Vasa. 2001; 43: 55.




Interventional Cardiology

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.