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PFO and paradoxical embolism producing events other than stroke.
Catheter Cardiovasc Interv 2011; 77(6):903-9CC

Abstract

BACKGROUND

A patent foramen ovale (PFO) is a risk factor for cerebral events such as cryptogenic stroke, transient ischemic attacks, and migraine headaches. Far less commonly, PFO is associated with non-cerebral, paradoxical systemic embolic events such as myocardial infarction (MI), renal infarct, and limb ischemia. This report details the incidence of systemic paradoxical emboli at our institution.

METHODS

416 patients were referred for evaluation of PFO related conditions from 2001 to 2009. Clinical history and medical records of the patients were reviewed for incidence of cryptogenic stroke, transient ischemic attack (TIA), migraine headache, arterial desaturation, and noncerebral systemic embolism.

RESULTS

As the primary presenting symptom, 219 patients had a diagnosis of cryptogenic stroke, 38 patients had migraine headaches, and 80 patients had transient neurologic deficits consistent with a TIA or complex headache. Twelve patients (2.9% of the total population) presented with a presumptive diagnosis of systemic embolism. Eight of these patients had acute MI diagnosed by elevated cardiac biomarkers, electrocardiogram changes, and/or imaging evidence of a left ventricular wall motion abnormality, without evidence of obstructive coronary disease on angiography. Four patients had evidence of peripheral embolism to a systemic artery, including the popliteal artery, ophthalmic artery, and brachial artery. PFO closure was performed in 197 patients (47.4% of the total population), including eight patients in the systemic embolism group. All closure procedures were successful.

CONCLUSION

Although most paradoxical emboli travel to the brain, noncerebral paradoxical embolism is also associated with PFO. In addition to embolism of thrombus, there may be paradoxical passage of vasoactive chemicals that induce intense coronary spasm and myocardial infarction. Diagnosis is often challenging, given the lack of definitive criteria and the need to exclude other potential etiologies.

Authors+Show Affiliations

Department of Medicine, Cardiology Division, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21207422

Citation

Dao, Catherine N., and Jonathan M. Tobis. "PFO and Paradoxical Embolism Producing Events Other Than Stroke." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 77, no. 6, 2011, pp. 903-9.
Dao CN, Tobis JM. PFO and paradoxical embolism producing events other than stroke. Catheter Cardiovasc Interv. 2011;77(6):903-9.
Dao, C. N., & Tobis, J. M. (2011). PFO and paradoxical embolism producing events other than stroke. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 77(6), pp. 903-9. doi:10.1002/ccd.22884.
Dao CN, Tobis JM. PFO and Paradoxical Embolism Producing Events Other Than Stroke. Catheter Cardiovasc Interv. 2011 May 1;77(6):903-9. PubMed PMID: 21207422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - PFO and paradoxical embolism producing events other than stroke. AU - Dao,Catherine N, AU - Tobis,Jonathan M, Y1 - 2011/03/16/ PY - 2010/07/12/received PY - 2010/10/15/revised PY - 2010/10/19/accepted PY - 2011/1/6/entrez PY - 2011/1/6/pubmed PY - 2011/8/16/medline SP - 903 EP - 9 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 77 IS - 6 N2 - BACKGROUND: A patent foramen ovale (PFO) is a risk factor for cerebral events such as cryptogenic stroke, transient ischemic attacks, and migraine headaches. Far less commonly, PFO is associated with non-cerebral, paradoxical systemic embolic events such as myocardial infarction (MI), renal infarct, and limb ischemia. This report details the incidence of systemic paradoxical emboli at our institution. METHODS: 416 patients were referred for evaluation of PFO related conditions from 2001 to 2009. Clinical history and medical records of the patients were reviewed for incidence of cryptogenic stroke, transient ischemic attack (TIA), migraine headache, arterial desaturation, and noncerebral systemic embolism. RESULTS: As the primary presenting symptom, 219 patients had a diagnosis of cryptogenic stroke, 38 patients had migraine headaches, and 80 patients had transient neurologic deficits consistent with a TIA or complex headache. Twelve patients (2.9% of the total population) presented with a presumptive diagnosis of systemic embolism. Eight of these patients had acute MI diagnosed by elevated cardiac biomarkers, electrocardiogram changes, and/or imaging evidence of a left ventricular wall motion abnormality, without evidence of obstructive coronary disease on angiography. Four patients had evidence of peripheral embolism to a systemic artery, including the popliteal artery, ophthalmic artery, and brachial artery. PFO closure was performed in 197 patients (47.4% of the total population), including eight patients in the systemic embolism group. All closure procedures were successful. CONCLUSION: Although most paradoxical emboli travel to the brain, noncerebral paradoxical embolism is also associated with PFO. In addition to embolism of thrombus, there may be paradoxical passage of vasoactive chemicals that induce intense coronary spasm and myocardial infarction. Diagnosis is often challenging, given the lack of definitive criteria and the need to exclude other potential etiologies. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/21207422/PFO_and_paradoxical_embolism_producing_events_other_than_stroke_ L2 - https://doi.org/10.1002/ccd.22884 DB - PRIME DP - Unbound Medicine ER -