Diagnosis and management of paradoxical embolism and patent foramen ovale

Current Opinion in Cardiology

Volumn 11, Issue 5, 1996, Pages 519-524

  Mas, Jean Louis ^a  

^a CENTRE HOSPITALIER SAINTE ANNE   (France)

Author keywords

[No Author keywords available]

Indexed keywords

ANTICOAGULANT AGENT; ANTITHROMBOCYTIC AGENT;

ARTERY EMBOLISM; ECHOCARDIOGRAPHY; EMBOLECTOMY; HEART ATRIUM SEPTUM DEFECT; HUMAN; LONG TERM CARE; PRIORITY JOURNAL; RECURRENCE RISK; REVIEW; RISK ASSESSMENT; THROMBUS;

EID: 0029743895     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001573-199609000-00011     Document Type: Review

References (26)

1. Johnson BI: Paradoxical embolism. J Clin Pathol 1951, 4:316-332.
2. Hagen PT, Scholz DG, Edwards WD: Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984, 59:17-20.
3. Christie J, Robinson CM, Pell ACH, McBirnie J, Burnett R: Transcardiac • echocardiography during Invasive intramedullary procedures. J Bone Joint Surg 1995, 77:450-455. Transesophageal echocardiography was performed during invasive intramedullary procedures in 110 patients. Embolic events of varying intensity were seen in 97 procedures. Paradoxical embolization occurred in four patients.
4. Ward R, Jones D, Haponik EF: Paradoxical embolism: an underrecog• nized problem. Chest 1995, 108:549-558. Includes an interesting discussion on management issues.
5. Cohnheim J: Thrombose und Embolie. In Vorlesungen über Allgemeine Pathologie, vol 1, Berlin: Hirschwald; 1877:136.
6. Zahn FW: Untersuchungen über Thrombose. Virchows Arch Path Anat 1889, 115:71.
7. Gill TJ, Campbell CC: Radial artery occlusion by a paradoxical embolism: a case report J Hand Surg 1995, 20:406-407.
8. Hust MH, Staiger M, Braun B: Migration of paradoxic embolus through • a patent foramen ovale diagnosed by echocardiography: successful thrombolysls. Am Heart J 1995, 129:620-622. An 8-cm serpentinelike thrombus crossing a PFO was found by transthoracic echocardiography in a woman with multiple pulmonary emboli. She was treated successfully with intravenous thrombolysis. Further migration of thrombus into left atrium was documented by repeated echocardiography.
9. Caes FL, Van Belleghem YV, Missault LH, Coenye KE, Van Nooten GJ: Surgical treatment of impending paradoxical embolism through patent foramen ovale. Ann Thorac Surg 1995, 59:1559-1561.
10. Zerio C, Canterin FA, Pavan D, Nicolosi GL: Spontaneous closure of a patent foramen ovale and disappearance of impending paradoxical embolism after fibrinolytic therapy in the course of massive pulmonary embolism. Am J Cardiol 1995, 76:422-424.
11. Mathew TC, Ramsaran EK, Aragam JR: Impending paradoxic embolism in acute pulmonary embolism: diagnosis by transesophageal echocardiography and treatment by emergent surgery. Am Heart J 1995, 129:826-827.
12. Balli E, Alfieri A, Del Citerna F: Direct evidence of patent foramen ovale as a route for paradoxical embolism. Br Heart J 1995, 74:470.
13. Paolo Anzola G, Renaldini E, Magoni M, Costa A, Cobelli M, Guindani M: Validation of transcranial Doppler sonography in the assessment of patent foramen ovale. Cerebrovasc Dis 1995, 5:194-198.
14. Mas JL: Patent foramen ovale, atrial septal aneurysm and ischaemic stroke in young adults. Eur Heart J 1994, 15:446-449.
15. Hausmann D, Mugge A, Daniel WG: Identification of patent foramen •• ovale permitting paradoxic embolism. J Am Coll Cardiol 1995, 26:1030-1038. In this analysis of the morphologic and functional characteristics of the PFO in patients with different clinical likelihoods of paradoxic embolism, right-to-left contrast shunting was more severe and opening of the PFO larger in patients with ischemic events considered to be due to paradoxic embolism.
16. Schneider B, Hofmann T, Justen MH, Meinertz T: Chiari's network: •• normal anatomic variant or risk factor for arterial embolic events? J Am Coll Cardiol 1995, 26:203-210. Chiari's network was found in 29 (2%) of 1436 consecutive patients undergoing TEE. It was frequently associated with PFO (83%) and ASA (24%) and was significantly more common in patients undergoing echocardiography because of unexplained arterial embolism than in patients evaluated for other indications. In association with a PFO and deep venous thrombosis, patients with this anomaly may be at a higher nsk for paradoxic embolization from a streaming effect within the right atrium.
17. Cabanes L, Mas JL, Cohen A, Amarenco P, Cabanes PA, Oubary P, Chedru F, Guérin F, Bousser MG, de Recondo J: Atrial septalaneurysm and patent foramen ovale is risk factors for cryptogenic stroke in patients less than 55 years of age: a study using transesophageal echocardiography. Stroke 1993, 24:1865-1873.
18. Mugge A, Daniel WG, Angermann C, Spes C, Khanderia BK, Kronzon I, • Freedberg RS, Keren A, Denning K, Engberding BK, et al. Atrial septal aneurysm in adult patients: a multicenter study using transthoracic and transesophageal echocardiography. Circulation 1995, 91:2785-2792. This multicenter retrospective study confirms that the most common abnormalities associated with ASA are interatrial shunts, in particular PFO, and that patients with ASA (especially with shunts) show a high frequency of previous clinical events compatible with cardiogenic embolism. However, thrombi attached to ASAs as detected by TEE are apparently rare (1%).
19. Fisher DC, Fisher EA, Budd JH, Rosen SE, Goldman ME: The incidence of patent foramen ovale in 1,000 consecutive patients: a contrast transesophageal echocardiography study. Chest 1995, 107:1504-1509.
20. Chammas E, Trinca M, Goullard L, Leys D, Houdas Y: Multiple cerebral infarcts associated with an atrial septal aneurysm: superimposed thrombus detected by transesophageal echocardiography. Angiology 1995, 46:327-331.
21. Bhagwat A, Meleca M, Hoit BD: Spontaneous echo contrast in a large atrial septal aneurysm. Am Heart J 1995, 130:193-194.
22. Mas JL, Zuber M, for the French Study Group on Patent Foramen Ovale •• and Atrial Septal Aneurysm: Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack. Am Heart J 1995, 130:1083-1088. This is the first study to provide an estimate of the risk of recurrent stroke associated with PFO, ASA, or both on the basis of a relatively large number of patients (n = 132 patients under 60 years of age). As a group, patients with PFO, ASA, or both and an otherwise unexplained stroke or TIA had a low risk of recurrent stroke (1.2% per year), whatever the prophylactic antithrombotic therapy used. In patients with both PFO and ASA, the annual risk of recurrent stroke was 4.4%. However, because few events were observed, the Cts of these estimates are wide.
23. Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, Lock JE: Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation 1992, 86:1902-1908.
24. Schulman S, Rhedin AS, Lindmarker R, et al.: A comparison of six •• weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med 1995, 332:1661-1665. Six months of prophylactic oral anticoagulation after a first episode venous thromboembolism led to a lower recurrence rate than did treatment lasting for 6 weeks.
25. Hirsh J: The optimal duration of anticoagulant therapy for venous • thrombosis. N Engl J Med 1995, 332:1710-1711. A thorough discussion on the optimal duration of anticoagulant therapy for venous thrombosis.
26. Homma S: PFO in Cryptogenic Stroke Study (PICSS) [abstract]. Stroke 1995, 26:1981.