Patent foramen ovale and atrial fibrillation as causes of cryptogenic stroke: is treatment with surgery superior to device closure and anticoagulation? A review of the literature
| Autor: | Thomas Kjeld, Gitte G. Fornitz, Tem Jørgensen, Henrik Arendrup, Jan Roland |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Heart disease Review 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Paradoxical embolism Pfo closure Medicine atrial fibrillation 030212 general & internal medicine Stroke transesophageal echocardiography business.industry paradoxical embolism Atrial fibrillation General Medicine medicine.disease stroke Surgery Cryptogenic stroke Atrial septum defect Embolism cryptogenic stroke Patent foramen ovale business |
| Zdroj: | Kjeld, T, Jørgensen, T S, Fornitz, G, Roland, J & Arendrup, H C 2018, ' Patent foramen ovale and atrial fibrillation as causes of cryptogenic stroke : is treatment with surgery superior to device closure and anticoagulation? A review of the literature ', Acta Radiologica Open, vol. 7, no. 9 . https://doi.org/10.1177/2058460118793922 Acta Radiologica Open |
| ISSN: | 2058-4601 |
| DOI: | 10.1177/2058460118793922 |
| Popis: | Closure of persistent foramen ovale (PFO) to avoid cryptogenic strokes is performed globally with enthusiasm but lacks prove of efficacy. We present a 79-year-old man who had had a PFO device introduced nine years previously because of cryptogenic strokes presenting as syncopes. The patient was referred from his general practitioner with two new syncopes. Transthoracic echocardiography revealed no cardiac causes of embolism. Transesophageal echocardiography (TEE) revealed a misplaced device like an umbrella in a storm, but no septum defects. Holter revealed seconds-long episodes of atrial fibrillation (AF). The patient was successfully treated with anticoagulation. A literature review showed that: (i) the efficacy of PFO closure devices has not been proven in any trial, but was demonstrated in a meta-analysis comparing three different devices; (ii) PFO devices are rarely controlled by TEE during or after insertion; (iii) residual shunts are detected in up to 45% of cases; (iv) there is an increased rate of post-arrhythmic complications; (v) the risk of AF in congenital heart disease increases with increasing age, with a 13% risk of transient ischemic attacks and stroke; and (vi) surgical treatment of PFO was found to have a 4.1% risk of complications including stroke. The question to be asked is whether device closure of PFO should be avoided, considering that PFO is a congenital heart defect with risks of AF and (cryptogenic) stroke? Heart surgery should be a treatment option for symptomatic PFO. |
| Databáze: | OpenAIRE |
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