Systematic surgical closure of patent foramen ovale in selected patients with cerebrovascular events due to paradoxical embolism. Early results of a preliminary study
| Autor: | X. Jeanrenaud, Michel Hurni, Julien Bogousslavsky, Patrick Ruchat, L. K. Von Segesser, A. Fischer |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Heart disease Population Foramen secundum Heart Septal Defects Atrial Persistent fetal circulation Brain Ischemia Paradoxical embolism Recurrence Risk Factors medicine Humans Prospective Studies Registries cardiovascular diseases education Stroke education.field_of_study business.industry Vascular disease General Medicine Middle Aged medicine.disease Surgery Ischemic Attack Transient Patent foramen ovale Female Cardiology and Cardiovascular Medicine business Embolism Paradoxical Follow-Up Studies |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 11:824-827 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/s1010-7940(97)01175-5 |
| Popis: | Objective: To define therapeutic strategy for management of patients with ischemic stroke due to a high probability of paradoxical embolism through a Patent Foramen Ovale (PFO). Methods: Since 1988 all consecutive patients with cerebrovascular events and PFO from the Stroke Registry of our population-based primary-care center are prospectively studied and followed. Since 1992, among 118 patients with cryptogenic embolic brain infarct or transient ischemic attack (TIA) and PFO, 32 consecutive patients younger than 60 years who presented at least two of the following criteria were admitted for surgery: history of Valsalva strain before stroke (11); multiple clinical events (13); multiple infarcts on brain Magnetic Resonnance Imaging (MRI) (15); atrial septal aneurysm (ASA) (16); large right-to-left shunt (\ 50 microbubbles) (12). Results: Operative time 135%9 33%. CPB time 34%914%. Aortic crossclamping time 16%96%. Post-operative bleeding 4859 170 ml. No homologous blood transfusion required. No neurological, cardiac or renal complications. All patients were followed-up corresponding to a cumulative time of 601 patient-months. This revealed no reccurent vascular events nor silent new brain lesions on brain MRI. Systematic simultaneous contrast Trans Esophageal Echocardiography (TEE)—Trans Cranial Doppler showed a small residual interatrial shunt in two patients. Conclusion: Surgical closure of a patent foramen ovale can be accomplished with very low morbidity and reduce efficently the risk of stroke recurrence. It seems to be the option of choice in selected patients with a higher (\ 1.5%: year) risk of stroke recurrence. © 1997 Elsevier Science B.V. |
| Databáze: | OpenAIRE |
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