UNASSIGNED: To evaluate and compare the diagnostic value of contrast-enhanced transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) for right to left shunt (RLS) in patent foramen ovale (PFO) by meta-analysis.
UNASSIGNED: The literature included in the Cochrane Library, PubMed, and Embase were searched by using \"contrast-enhanced transcranial Doppler (c-TCD), contrast-enhanced transthoracic echocardiography (c-TTE), patent foramen ovale (PFO), and right to left shunt (RLS)\" as the keywords from inception through April 30, 2024. The diagnostic accuracy research quality assessment tool (QUADAS-2) was used to evaluate the quality of the included literature. The combined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and Diagnostic odds ratio (DOR) were pooled, and a comprehensive ROC curve analysis was performed. Statistical software StataSE 12.0 and Meta-Disc 1.4 were used for data analysis.
UNASSIGNED: A total of 8,536 articles were retrieved, and 9 articles that met all inclusion criteria were included in this meta-analysis. The meta-analysis results show that the combined sensitivity, specificity, PLR, NLR, DOR, and area under the SROC curve of c-TCD for the diagnose of PFO-RLS were 0.91 (95% CI, 0.88-0.93), 0.87 (95% CI: 0.84-0.91), 6.0 (95% CI, 2.78-12.96), 0.10 (95% CI, 0.06-0.18), 91.61 (95% CI, 26.55-316.10), and 0.9681, respectively; the corresponding values of c-TTE were 0.86 (95% CI, 0.84-0.89), 0.88 (95% CI, 0.84-0.91), 5.21 (95% CI, 2.55-10.63), 0.16 (95% CI, 0.09-0.31), 71.43 (95% CI, 22.85-223.23), and 0.9532. The ROC curve shows that c-TCD has slightly higher diagnostic value for PFO than c-TTE, but there is no significant statistical difference (Z = 0.622, p > 0.05). Deek funnel pattern showed no significant publication bias.
UNASSIGNED: Both c-TCD and c-TTE have high diagnostic values for PFO-RLS. However, c-TCD has slightly higher sensitivity and lower specificity in diagnosing PFO-RLS compared to c-TTE.Systematic review registration: identifier [CRD42024544169].

A 73-year-old female patient was diagnosed with lumbar spinal stenosis by an orthopedic surgeon. During admission for further evaluation, she was found to have hypoxemia. Contrast-enhanced computed tomography revealed a 43-mm ascending aortic aneurysm, but there were no signs of pulmonary embolism, and no abnormalities were detected in the lung fields. Upon initiating rehabilitation in the standing position, respiratory distress and hypoxemia worsened. Careful observation revealed that hypoxemia worsened in the seated position but normalized while lying down. We considered the possibility of platypnea-orthodeoxia syndrome (POS), in which hypoxemia worsens in the seated position. Transesophageal echocardiography revealed that a patent foramen ovale (PFO), which was hardly noticeable while lying down, worsened in the seated position. A pulmonary perfusion scan showed a 27 % right-to-left shunt. Cardiac catheterization confirmed the presence of right-to-left shunting during right atrial injection. Consequently, it was diagnosed that the ascending aortic aneurysm aggravated the PFO in the seated position, leading to POS. The PFO was unsuitable for transcatheter treatment. Consequently, the patient underwent direct closure surgery in the cardiac surgery department. Postoperatively, the patient\'s hypoxemia and respiratory distress in the seated position improved, and subsequent progress has been favorable.
UNASSIGNED: Diagnosing platypnea-orthodeoxia syndrome in patients with poor activities of daily living (ADL) is challenging. Careful observation of the percutaneous oxygen saturation in both supine and seated positions is crucial, and a transesophageal echocardiogram in the supine and seated positions is inevitable. Lung perfusion scintigraphy is often used to evaluate the cause of hypoxemia; however, whole-body scans are important for detecting the presence and number of right-left shunts. This case report highlights the pitfalls of diagnosis in patients with poor ADL.

BACKGROUND: Interatrial septum (IAS) could be redundant by abnormal movement with or without aneurysmal bulging. We aimed to determine the prevalence of isolated redundant and aneurysmal IAS motion and their probable relationship with age and presence of patent foramen ovale (PFO) in a large-scale referral center.
METHODS: A total of 15,288 patients who underwent transthoracic echocardiography (TTE) at Tehran Heart Center were included From March 2019 to March 2021. Contrast echocardiography was conducted on patients with suspected PFO. Data were retrospectively analyzed from our previously established database. The prevalence of aneurysmal and redundant IAS and their relationship with age and PFO presence was evaluated.
RESULTS: Aneurysmal and isolated redundant IAS were present in 4% and 12.4% of the participants, respectively. The aneurysmal group was older, more frequently female and had higher frequency of PFO. The frequency of PFO among patients with aneurysmal IAS was about 14.4% and 5.3% in isolated redundant IAS patients. In both groups, the prevalence of abnormal IAS motion increased across age groups from the youngest to the oldest, while the prevalence of PFO decreased.
CONCLUSIONS: In conclusion, the frequency of PFO among patients with aneurysmal IAS was about 2.5 times more than that among patients with isolated redundant IAS and 24 times more than the normal population. The increasing trend observed across the aging group proposes a potential role for age in the pathophysiology of abnormal IAS. Furthermore, the decreasing prevalence of PFO among patients underlies its clinical significance as an important risk factor.

The foramen ovale plays a vital role in sustaining life in-utero; however, a patent foramen ovale (PFO) after birth has been associated with pathologic sequelae in the systemic circulation including stroke/transient ischemic attack (TIA), migraine, high altitude pulmonary edema, decompression illness, platypnea-orthodeoxia syndrome (POS) and worsened severity of obstructive sleep apnea. Importantly, each of these conditions is most commonly observed among specific age groups: migraine in the 20-40s, stroke/TIA in the 30-50s and POS in patients >50 years of age. The one common and central pathophysiologic mechanism in each of these conditions is PFO-mediated shunting of blood and its contents from the right to the left atrium. PFO-associated pathologies can therefore be divided into (1) paradoxical systemic embolization and (2) right to left shunting (RLS) of blood through the PFO. Missing in the extensive literature on these clinical syndromes are mechanistic explanations for the occurrence of RLS, including timing and the volume of blood shunted, the impact of age on RLS, and the specific anatomical pathway that blood takes from the venous system to the left atrium. Visualization of the flow pattern graphically illustrates the underlying RLS and provides a greater understanding of the critical flow dynamics that determine the frequency, volume, and pathway of flow. In the present review, we describe the important role of foramen ovale in in-utero physiology, flow visualization in patients with PFO, as well as contributing factors that work in concert with PFO to result in the diverse pathophysiological sequelae.

UNASSIGNED: Patent foramen ovale (PFO) is seen in 25% of the general population but in up to 50% of patients ≤60 years old with cryptogenic strokes. Trials have shown that PFO closure vs medical therapy reduces the risk of future strokes. PFO closure may cause atrial fibrillation (AF), with prior trials reporting an incidence of 2% to 11.9%. However, the true incidence of AF after PFO closure is unknown due to limitations in prior studies for long-term monitoring.
UNASSIGNED: This is a retrospective observational study at a single center. Patients who underwent PFO closure and had an implantable loop recorder prior to PFO closure were included. The final review included 38 patients who had at least 2 months of implantable loop recorder data post-PFO closure.
UNASSIGNED: Ten out of 38 (26%) patients developed AF post-PFO closure. The median time to the first episode of AF was 3.95 weeks, with 40% having their first AF episode after 3 months. Median duration of AF episodes was 1 hour. One hundred percent had spontaneous termination of AF. Of the AF patients, 70% were started on oral anticoagulant therapy.
UNASSIGNED: Our review shows a higher incidence of AF post-PFO closure as compared with most reported prior studies. We recommend larger prospective studies to explore the true incidence of AF post-PFO closure, its clinical impact, and subsequent stroke risk.

暂无摘要。

UNASSIGNED: Patients with a patent foramen ovale (PFO) who undergo percutaneous PFO closure are at a greater risk of developing atrial fibrillation (AF) compared with patients whose PFOs are managed medically. Postclosure AF appears to be well tolerated if treated but may increase the risk for stroke. Postclosure AF is reported to occur in 3.7% to 7.4% of patients; however, incidence across devices remains uncertain. This study aims to evaluate the frequency of postclosure AF, atrial flutter, and arrhythmias in 6 PFO closure devices.
UNASSIGNED: Four hundred forty-five patients underwent percutaneous PFO closure with appropriate follow-up between 2001 and 2021. The procedure was performed using Abbott Amplatzer PFO, Amplatzer ASD, Amplatzer Cribriform, NMT CardioSEAL, Gore Helex, or Gore Cardioform devices. Incidence of AF, atrial flutter, and arrhythmias were assessed by electrocardiogram within 6 months from closure. Multivariate logistic regression evaluated potential predictors of postclosure AF or atrial flutter.
UNASSIGNED: Postclosure AF or atrial flutter occurred in 30 patients (6.7%) within 6 months, and its incidence was significantly different across devices. Gore Cardioform had the greatest frequency of postclosure AF or atrial flutter events (16.8%) compared with other devices. The Gore Cardioform device, larger device sizes, and male sex were associated with greater risk of postclosure AF or atrial flutter.
UNASSIGNED: Postclosure AF or atrial flutter was more likely to occur in the Gore Cardioform device, in males, and in patients who underwent PFO closure with larger devices. Although it is more effective for complete closure, the Gore Cardioform device was shown to be an independent predictor of postclosure AF or atrial flutter.

暂无摘要。

OBJECTIVE: The CABANA study shows that atrial fibrillation (AF) paitents younger than 65 years benefit more from the AF radiofrequency catheter ablation (RFCA) procedure. The aim of this study is to investigate the impact of inherent patent foramen ovale (PFO) with a Left-to-Right Shunt on the RFCA procedure in young AF patients.
METHODS: Based on the presence or absence of inherent PFO, the AF patients were divided into the PFO groups and the non-PFO group. Clinical follow-up was also investigated.
RESULTS: A total of 285 AF patients were enrolled. PFO was detected by TEE in 42 patients. The age of patients at initial AF onset was younger in the PFO group than in the non-PFO group (58.3 ± 8.9 vs. 62.3 ± 9.6 years, P = 0.012). There were more AF patients aged <55 years in the PFO group than in the non-PFO group. For the 9 AF patients with PFO who experienced AF recurrence and the left-to-right shunts decreased in size in 5 of the patients aged <65 years. The LAD decreased in those patients. In the PeAF patients, 53/64 patients aged <65 years and 23/40 patients aged older than 65 years were free of AF (82.8 % vs. 57.5 %, respectively; P = 0.005).
CONCLUSIONS: Success is not affected when AF is combined PFO compared with AF without PFO. Young patients have better PeAF RFCA outcomes. AF in young patients with left atria enlargement and a serious AF burden, may lead to reduced EF and render PFO easy to detect.

UNASSIGNED: Myocardial infarction (MI) caused by patent foramen ovale (PFO)-based paradoxical embolism is rare, and there are few case reports in the literature.
UNASSIGNED: Here, we report a case of MI in which optical coherence tomography revealed in situ thrombi in the PFO channel.
UNASSIGNED: In addition to paradoxical embolism, in situ thrombus may also be one of the pathogenic mechanisms of PFO in patients with MI.