Prognosis after stroke followed by surgical closure of patent foramen ovale
| Autor: | Julien Bogousslavsky, Hossein Sadeghi, Paul-André Despland, Gérald Devuyst, Michel Guffi, Franco Regli, Veronica Castillo, Patrick Ruchat, Xavier Jeanrenaud, Nicole Aebischer, Hakan Karpuz |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Heart Septum medicine Valsalva maneuver Humans Prospective Studies cardiovascular diseases Stroke Foramen ovale (heart) medicine.diagnostic_test business.industry Brain Magnetic resonance imaging Middle Aged Prognosis medicine.disease Echoencephalography Magnetic Resonance Imaging Heart septum Transcranial Doppler Surgery Cerebrovascular Disorders medicine.anatomical_structure Embolism Patent foramen ovale Female Neurology (clinical) business Follow-Up Studies |
| Zdroj: | Neurology. 47:1162-1166 |
| ISSN: | 1526-632X 0028-3878 |
| Popis: | Background: The risk of stroke and the long-term prognosis of recurrent strokes in young patients with patent foramen ovale (PFO) are not well known. For this reason, the treatment of these patients remains empirical. An alternative treatment to prolonged antithrombotic therapy may be surgical closure of the PFO. Methods: Thirty patients (20 men and 10 women) with stroke and PFO were prospectively selected among 138 patients with stroke and PFO for a study of surgical closure of PFO at our center. Eligible patients were 50 microbubbles counted in the left atrium on contrast transesophageal echocardiography (TEE), and (4) Valsalva maneuver or cough preceding the stroke. Patients selected in this manner for surgery were considered to be a subgroup with a higher risk of stroke recurrence. Results: All patients had a direct suture of PFO while under cardiopulmonary bypass without recorded early or delayed significant complication. All patients underwent a new brain MRI and TEE simultaneous with transcranial Doppler ultrasonography after contrast injection at 8 +/- 3 months after surgery. After a mean follow-up of 2 years without antithrombotic treatment, no recurrent cerebrovascular event (stroke or transient ischemic attack [TIA]) and no new lesion on MRI had developed. Postoperative contrast TEE and transcranial Doppler ultrasonography showed that two patients had residual interatrial right-to-left shunting, although much smaller than before surgery, associated with single versus double continuous suture. Conclusions: Our study of 30 selected stroke patients with surgical suture of PFO showed a stroke recurrence rate of 0% and no significant complication. Residual right-to-left shunting may be avoided by double continuous suture of the PFO. In the absence of controlled studies to guide individual therapeutic decisions, our findings show that PFO closure can be done safely and may be considered to avoid recurrence in selected patients with long life expectancy and presumed paradoxic embolism.NEUROLOGY 1996;47: 1162-1166 |
| Databáze: | OpenAIRE |
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