Clinical manifestation and current management of patent foramen ovale

Expert Review of Cardiovascular Therapy

Volumn 7, Issue 8, 2009, Pages 1011-1022

  Cruz González, Ignacio ^a   Solis, Jorge ^b   Kiernan, Thomas J ^b   Yan, Bryan P ^c,d   Lam, Yat Yin ^c   Palacios, Igor F ^b  

^a HOSPITAL UNIVERSITARIO DE SALAMANCA   (Spain)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

^c CHINESE UNIVERSITY OF HONG KONG   (Hong Kong)

^d MONASH UNIVERSITY   (Australia)

Author keywords

Cryptogenic stroke; Migraine; Patent foramen ovale; Percutaneous device closure

Indexed keywords

ACETYLSALICYLIC ACID; ANTICOAGULANT AGENT; ANTITHROMBOCYTIC AGENT; CLOPIDOGREL; DIPYRIDAMOLE; WARFARIN;

ALTITUDE DISEASE; BLEEDING; BRAIN DISEASE; BRAIN ISCHEMIA; CEREBROVASCULAR ACCIDENT; CHRONIC OBSTRUCTIVE LUNG DISEASE; CLINICAL EFFECTIVENESS; CLINICAL TRIAL; CLIP; CORONARY ARTERY DISEASE; DISEASE ASSOCIATION; DOPPLER ECHOGRAPHY; DYSPNEA; HEART ATRIUM SEPTUM DEFECT; HUMAN; HYPERTENSION; HYPOXEMIA; INTERNATIONAL NORMALIZED RATIO; INTRACARDIAC ECHOCARDIOGRAPHY; LUNG EDEMA; LUNG EMBOLISM; MIGRAINE; PATENT FORAMEN OVALE; REVIEW; SECONDARY PREVENTION; SLEEP APNEA SYNDROME; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; TRANSIENT ISCHEMIC ATTACK; TRANSTHORACIC ECHOCARDIOGRAPHY; VEIN THROMBOSIS; ANOXIA; ECHOCARDIOGRAPHY; METHODOLOGY; RISK FACTOR; STROKE; SYNDROME;

ANOXIA; DYSPNEA; ECHOCARDIOGRAPHY; ECHOCARDIOGRAPHY, TRANSESOPHAGEAL; FORAMEN OVALE, PATENT; HUMANS; MIGRAINE DISORDERS; RISK FACTORS; STROKE; SYNDROME; ULTRASONOGRAPHY, DOPPLER, TRANSCRANIAL;

EID: 70350442798     PISSN: 14779072     EISSN: 17448344     Source Type: Journal    
DOI: 10.1586/erc.09.62     Document Type: Review

References (98)

1. 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. 59(1), 17-20 (1984).
2. Lechat P, Mas JL, Lascault G et al. Prevalence of patent foramen ovale in patients with stroke. N. Engl. J. Med. 318(18), 1148-1152 (1988). (Pubitemid 18117693)
3. Medina A, de Lezo JS, Caballero E, Ortega JR. Platypnea - orthodeoxia due to aortic elongation. Circulation 104(6), 741 (2001). (Pubitemid 32738533)
4. Torti SR, Billinger M, Schwerzmann M et al. Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale. Eur. Heart J. 25(12), 1014-1020 (2004). (Pubitemid 38869419)
5. Anzola GP, Magoni M, Guindani M, Rozzini L, Dalla Volta G. Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology 52(8), 1622-1625 (1999). (Pubitemid 29220637)
6. Meissner I, Whisnant JP, Khandheria BK et al. Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC study. Stroke prevention: assessment of risk in a community. Mayo Clin. Proc. 74(9), 862-869 (1999).
7. Homma S, Sacco RL. Patent foramen ovale and stroke. Circulation 112(7), 1063-1072 (2005).
8. Kuhl HP, Hoffmann R, Merx MW et al. Transthoracic echocardiography using second harmonic imaging: diagnostic alternative to transesophageal echocardiography for the detection of atrial right to left shunt in patients with cerebral embolic events. J. Am. Coll. Cardiol. 34(6), 1823-1830 (1999).
9. Ha JW, Shin MS, Kang S et al. Enhanced detection of right-to-left shunt through patent foramen ovale by transthoracic contrast echocardiography using harmonic imaging. Am. J. Cardiol. 87(5), 669-671, A611 (2001). (Pubitemid 32178475)
10. Di Tullio M, Sacco RL, Massaro A et al. Transcranial Doppler with contrast injection for the detection of patent foramen ovale in stroke patients. Int. J. Card. Imaging 9(1), 1-5 (1993). (Pubitemid 23089224)
11. Devuyst G, Despland PA, Bogousslavsky J, Jeanrenaud X. Complementarity of contrast transcranial Doppler and contrast transesophageal echocardiography for the detection of patent foramen ovale in stroke patients. Eur. Neurol. 38(1), 21-25 (1997). (Pubitemid 27283074)
12. Belkin RN, Pollack BD, Ruggiero ML, Alas LL, Tatini U. Comparison of transesophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale. Am. Heart J. 128(3), 520-525 (1994). (Pubitemid 24298305)
13. Daniels C, Weytjens C, Cosyns B et al. Second harmonic transthoracic echocardiography: the new reference screening method for the detection of patent foramen ovale. Eur. J. Echocardiogr. 5(6), 449-452 (2004). (Pubitemid 40045651)
14. Madala D, Zaroff JG, Hourigan L, Foster E. Harmonic imaging improves sensitivity at the expense of specificity in the detection of patent foramen ovale. Echocardiography 21(1), 33-36 (2004). (Pubitemid 38183769)
15. Kronik G, Slany J, Moesslacher H. Contrast M-mode echocardiography in diagnosis of atrial septal defect in acyanotic patients. Circulation 59(2), 372-378 (1979). (Pubitemid 9138735)
16. Homma S, Di Tullio MR, Sacco RL, Mihalatos D, Li Mandri G, Mohr JP. Characteristics of patent foramen ovale associated with cryptogenic stroke. A biplane transesophageal echocardiographic study. Stroke 25(3), 582-586 (1994). (Pubitemid 24067070)
17. Hamann GF, Schatzer-Klotz D, Frohlig G et al. Femoral injection of echo contrast medium may increase the sensitivity of testing for a patent foramen ovale. Neurology 50(5), 1423-1428 (1998). (Pubitemid 28240364)
18. Schuchlenz HW, Weihs W, Horner S, Quehenberger F. The association between the diameter of a patent foramen ovale and the risk of embolic cerebrovascular events. Am. J. Med. 109(6), 456-462 (2000). (Pubitemid 30782694)
19. Ho SY, McCarthy KP, Rigby ML. Morphological features pertinent to interventional closure of patent oval foramen. J. Interv. Cardiol. 16(1), 33-38 (2003).
20. Jauss M, Zanette E. Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography. Cerebrovasc. Dis. 10(6), 490-496 (2000). (Pubitemid 30825394)
21. Ponnuthurai FA, van Gaal WJ, Burchell A, Mitchell AR, Wilson N, Ormerod OJ. Safety and feasibility of day case patent foramen ovale (PFO) closure facilitated by intracardiac echocardiography. Int. J. Cardiol. 131(3), 438-440 (2009).
22. Sacco RL, Ellenberg JH, Mohr JP et al. Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Ann. Neurol. 25(4), 382-390 (1989).
23. Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Ann. Intern. Med. 117(6), 461-465 (1992).
24. Steiner MM, Di Tullio MR, Rundek T et al. Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke. Stroke 29(5), 944-948 (1998). (Pubitemid 28228154)
25. Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A. Patent foramen ovale and cryptogenic stroke in older patients. N. Engl. J. Med. 357(22), 2262-2268 (2007). (Pubitemid 350190756)
26. Hausmann D, Mugge A, Becht I, Daniel WG. Diagnosis of patent foramen ovale by transesophageal echocardiography and association with cerebral and peripheral embolic events. Am. J. Cardiol. 70(6), 668-672 (1992).
27. Jones EF, Calafiore P, Donnan GA, Tonkin AM. Evidence that patent foramen ovale is not a risk factor for cerebral ischemia in the elderly. Am. J. Cardiol. 74(6), 596-599 (1994). (Pubitemid 24279942)
28. Mas JL, Arquizan C, Lamy C et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N. Engl. J. Med. 345(24), 1740-1746 (2001). (Pubitemid 34940229)
29. Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation 105(22), 2625-2631 (2002). (Pubitemid 34596039)
30. Meissner I, Khandheria BK, Heit JA et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J. Am. Coll. Cardiol. 47(2), 440-445 (2006). (Pubitemid 43063268)
31. Di Tullio MR, Sacco RL, Sciacca RR, Jin Z, Homma S. Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. J. Am. Coll. Cardiol. 49(7), 797-802 (2007). (Pubitemid 46240713)
32. De Castro S, Cartoni D, Fiorelli M et al. Morphological and functional characteristics of patent foramen ovale and their embolic implications. Stroke 31(10), 2407-2413 (2000). (Pubitemid 30740551)
33. Windecker S, Meier B. Is closure recommended for patent foramen ovale and cryptogenic stroke? Patent foramen ovale and cryptogenic stroke: to close or not to close? Closure: what else! Circulation 118(19), 1989-1998 (2008).
34. Falk V, Walther T, Krankenberg H, Mohr FW. Trapped thrombus in a patent foramen ovale. Thorac. Cardiovasc. Surg. 45(2), 90-92 (1997). (Pubitemid 27224021)
35. 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. 59(6), 1559-1561 (1995).
36. Chaturvedi S. Coagulation abnormalities in adults with cryptogenic stroke and patent foramen ovale. J. Neurol. Sci. 160(2), 158-160 (1998). (Pubitemid 28522540)
37. Kiernan TJ, Yan BP, Cubeddu RJ et al. May-Thurner syndrome in patients with cryptogenic stroke and patent foramen ovale: an important clinical association. Stroke 40(4), 1502-1504 (2009).
38. Mesa D, Franco M, Suarez de Lezo J et al. [Prevalence of patent foramen ovale in young patients with cerebral ischemic accident of unknown origin]. Rev. Esp. Cardiol. 56(7), 662-668 (2003).
39. Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology 55(8), 1172-1179 (2000). (Pubitemid 30802997)
40. Pezzini A, Del Zotto E, Magoni M et al. Inherited thrombophilic disorders in young adults with ischemic stroke and patent foramen ovale. Stroke 34(1), 28-33 (2003). (Pubitemid 36070795)
41. Karttunen V, Hiltunen L, Rasi V, Vahtera E, Hillbom M. Factor V Leiden and prothrombin gene mutation may predispose to paradoxical embolism in subjects with patent foramen ovale. Blood Coagul. Fibrinolysis 14(3), 261-268 (2003). (Pubitemid 36589148)
42. Botto N, Spadoni I, Giusti S, Ait-Ali L, Sicari R, Andreassi MG. Prothrombotic mutations as risk factors for cryptogenic ischemic cerebrovascular events in young subjects with patent foramen ovale. Stroke 38(7), 2070-2073 (2007). (Pubitemid 47012269)
43. Cramer SC, Rordorf G, Maki JH et al. Increased pelvic vein thrombi in cryptogenic stroke: results of the Paradoxical Emboli from Large Veins in Ischemic Stroke (PELVIS) study. Stroke 35(1), 46-50 (2004). (Pubitemid 38057588)
44. Mohr JP, Thompson JL, Lazar RM et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N. Engl. J. Med. 345(20), 1444-1451 (2001).
45. Bogousslavsky J, Garazi S, Jeanrenaud X, Aebischer N, Van Melle G. Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group. Neurology 46(5), 1301-1305 (1996).
46. Cujec B, Mainra R, Johnson DH. Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks. Can. J. Cardiol. 15(1), 57-64 (1999). (Pubitemid 29080518)
47. Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P. Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 Suppl.), S630-S669 (2008). (Pubitemid 351892974)
48. Messe SR, Silverman IE, Kizer JR et al. Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 62(7), 1042-1050 (2004).
49. Kizer JR, Devereux RB. Clinical practice. Patent foramen ovale in young adults with unexplained stroke. N. Engl. J. Med. 353(22), 2361-2372 (2005).
50. Windecker S, Wahl A, Chatterjee T et al. Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. Circulation 101(8), 893-898 (2000). (Pubitemid 30117885)
51. Khairy P, O'Donnell CP, Landzberg MJ. Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review. Ann. Intern. Med. 139(9), 753-760 (2003). (Pubitemid 38129075)
52. Braun M, Gliech V, Boscheri A et al. Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism. Periprocedural safety and mid-term follow-up results of three different device occluder systems. Eur. Heart J. 25(5), 424-430 (2004). (Pubitemid 38391525)
53. Post MC, Van Deyk K, Budts W. Percutaneous closure of a patent foramen ovale: single-centre experience using different types of devices and mid-term outcome. Acta Cardiol. 60(5), 515-519 (2005). (Pubitemid 41433658)
54. Slavin L, Tobis JM, Rangarajan K, Dao C, Krivokapich J, Liebeskind DS. Five-year experience with percutaneous closure of patent foramen ovale. Am. J. Cardiol. 99(9), 1316-1320 (2007). (Pubitemid 46659873)
55. Anzai H, Child J, Natterson B et al. Incidence of thrombus formation on the CardioSEAL and the Amplatzer interatrial closure devices. Am. J. Cardiol. 93(4), 426-431 (2004). (Pubitemid 38221349)
56. Krumsdorf U, Ostermayer S, Billinger K et al. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J. Am. Coll. Cardiol. 43(2), 302-309 (2004). (Pubitemid 38201160)
57. Drighil A, El Mosalami H, Elbadaoui N, Chraibi S, Bennis A. Patent foramen ovale: a new disease? Int. J. Cardiol. 122(1), 1-9 (2007). (Pubitemid 47503359)
58. Schoen SP, Boscheri A, Lange SA et al. Incidence of aortic valve regurgitation and outcome after percutaneous closure of atrial septal defects and patent foramen ovale. Heart 94(7), 844-847 (2008). (Pubitemid 351914691)
59. Schwerzmann M, Windecker S, Wahl A et al. Implantation of a second closure device in patients with residual shunt after percutaneous closure of patent foramen ovale. Catheter Cardiovasc. Interv. 63(4), 490-495 (2004). (Pubitemid 39578515)
60. Sacco RL, Adams R, Albers G et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Circulation 113(10), E409-E449 (2006). (Pubitemid 43739468)
61. Slottow TL, Steinberg DH, Waksman R. Overview of the 2007 Food and Drug Administration Circulatory System Devices Panel meeting on patent foramen ovale closure devices. Circulation 116(6), 677-682 (2007).
62. Dearani JA, Ugurlu BS, Danielson GK et al. Surgical patent foramen ovale closure for prevention of paradoxical embolism-related cerebrovascular ischemic events. Circulation 100(19 Suppl.), II171-II175 (1999).
63. Devuyst G, Bogousslavsky J, Ruchat P et al. Prognosis after stroke followed by surgical closure of patent foramen ovale: a prospective follow-up study with brain MRI and simultaneous transesophageal and transcranial Doppler ultrasound. Neurology 47(5), 1162-1166 (1996). (Pubitemid 26374880)
64. Nendaz MR, Sarasin FP, Junod AF, Bogousslavsky J. Preventing stroke recurrence in patients with patent foramen ovale: antithrombotic therapy, foramen closure, or therapeutic abstention? A decision analytic perspective. Am. Heart J. 135(3), 532-541 (1998). (Pubitemid 28125692)
65. Deeik RK, Thomas RM, Sakiyalak P, Botkin S, Blakeman B, Bakhos M. Minimal access closure of patent foramen ovale: is it also recommended for patients with paradoxical emboli? Ann. Thorac. Surg. 74(4), S1326-S1329 (2002). (Pubitemid 35176788)
66. Argenziano M, Oz MC, Kohmoto T et al. Totally endoscopic atrial septal defect repair with robotic assistance. Circulation 108 (Suppl. 1), II191-II194 (2003). (Pubitemid 37099953)
67. Chang CL, Donaghy M, Poulter N. Migraine and stroke in young women: case-control study. The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. BMJ 318(7175), 13-18 (1999).
68. Carolei A, Marini C, De Matteis G. History of migraine and risk of cerebral ischaemia in young adults. The Italian National Research Council Study Group on Stroke in the Young. Lancet 347(9014), 1503-1506 (1996).
69. Kruit MC, van Buchem MA, Hofman PA et al. Migraine as a risk factor for subclinical brain lesions. JAMA 291(4), 427-434 (2004).
70. Wilmshurst P, Pearson M, Nightingale S. Re-evaluation of the relationship between migraine and persistent foramen ovale and other right-to-left shunts. Clin. Sci. (Lond.) 108(4), 365-367 (2005). (Pubitemid 40517000)
71. Schwerzmann M, Nedeltchev K, Meier B. Patent foramen ovale closure: a new therapy for migraine. Catheter Cardiovasc. Interv. 69(2), 277-284 (2007). (Pubitemid 46214264)
72. Dowson A, Mullen MJ, Peatfield R et al. Migraine Intervention With STARFlex Technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache. Circulation 117(11), 1397-1404 (2008).
73. Carroll JD. Migraine Intervention With STARFlex Technology trial: a controversial trial of migraine and patent foramen ovale closure. Circulation 117(11), 1358-1360 (2008).
74. Shub C, Tajik AJ, Seward JB, Dines DE. Detecting intrapulmonary right-to-left shunt with contrast echocardiography. Observations in a patient with diffuse pulmonary arteriovenous fistulas. Mayo Clin. Proc. 51(2), 81-84 (1976).
75. Naqvi TZ, Nagai T, Atar S, Siegel RJ. Early appearance of echo-contrast simulating an intracardiac shunt in a patient with liver cirrhosis and intrapulmonary shunting. J. Am. Soc. Echocardiogr. 15(4), 379-381 (2002). (Pubitemid 44971150)
76. Godart F, Rey C, Prat A et al. Atrial right-to-left shunting causing severe hypoxaemia despite normal right-sided pressures. Report of 11 consecutive cases corrected by percutaneous closure. Eur. Heart J. 21(6), 483-489 (2000). (Pubitemid 30122136)
77. Cheng TO. Transcatheter closure of patent foramen ovale: a definitive treatment for platypnea-orthodeoxia. Catheter Cardiovasc. Interv. 51(1), 120 (2000).
78. Delgado G, Inglessis I, Martin-Herrero F et al. Management of platypnea-orthodeoxia syndrome by transcatheter closure of atrial communication: hemodynamic characteristics, clinical and echocardiographic outcome. J. Invasive Cardiol. 16(10), 578-582 (2004). (Pubitemid 40731713)
79. Guerin P, Lambert V, Godart F et al. Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia: results of a multicentric French registry. Cardiovasc. Intervent. Radiol. 28(2), 164-168 (2005). (Pubitemid 40754801)
80. Ortega Trujillo JR, Suarez de Lezo Herreros de Tejada J, Garcia Quintana A, Melian Nuez F, Rodriguez Delgado R, Medina Fernandez-Aceytuno A. [Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia]. Rev. Esp. Cardiol. 59(1), 78-81 (2006).
81. Vik A, Jenssen BM, Brubakk AO. Paradoxical air embolism in pigs with a patent foramen ovale. Undersea Biomed. Res. 19(5), 361-374 (1992).
82. Cartoni D, De Castro S, Valente G et al. Identification of professional scuba divers with patent foramen ovale at risk for decompression illness. Am. J. Cardiol. 94(2), 270-273 (2004). (Pubitemid 38902891)
83. Hacievliyagil SS, Gunen H, Kosar FM, Sahin I, Kilic T. Prevalence and clinical significance of a patent foramen ovale in patients with chronic obstructive pulmonary disease. Respir. Med. 100(5), 903-910 (2006).
84. Soliman A, Shanoudy H, Liu J, Russell DC, Jarmukli NF. Increased prevalence of patent foramen ovale in patients with severe chronic obstructive pulmonary disease. J. Am. Soc. Echocardiogr. 12(2), 99-105 (1999). (Pubitemid 29091774)
85. Webb G, Gatzoulis MA. Atrial septal defects in the adult: recent progress and overview. Circulation 114(15), 1645-1653 (2006). (Pubitemid 44547435)
86. Shanoudy H, Soliman A, Raggi P, Liu JW, Russell DC, Jarmukli NF. Prevalence of patent foramen ovale and its contribution to hypoxemia in patients with obstructive sleep apnea. Chest 113(1), 91-96 (1998). (Pubitemid 28044930)
87. Beelke M, Angeli S, Del Sette M et al. Obstructive sleep apnea can be provocative for right-to-left shunting through a patent foramen ovale. Sleep 25(8), 856-862 (2002). (Pubitemid 35424528)
88. Johansson MC, Eriksson P, Peker Y, Hedner J, Rastam L, Lindblad U. The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea. Eur. Respir. J. 29(1), 149-155 (2007). (Pubitemid 46092012)
89. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N. Engl. J. Med. 353(19), 2034-2041 (2005). (Pubitemid 41609096)
90. Allemann Y, Hutter D, Lipp E et al. Patent foramen ovale and high-altitude pulmonary edema. JAMA 296(24), 2954-2958 (2006). (Pubitemid 46021499)
91. Konstantinides S, Geibel A, Kasper W, Olschewski M, Blumel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation 97(19), 1946-1951 (1998).
92. Knauth M, Ries S, Pohimann S et al. Cohort study of multiple brain lesions in sport divers: role of a patent foramen ovale. BMJ 314(7082), 701-705 (1997). (Pubitemid 27113070)
93. Purandare N, Oude Voshaar RC, McCollum C, Jackson A, Burns A. Paradoxical embolisation and cerebral white matter lesions in dementia. Br. J. Radiol. 81(961), 30-34 (2008). (Pubitemid 351154772)
94. Adami A, Rossato G, Cerini R et al. Right-to-left shunt does not increase white matter lesion load in migraine with aura patients. Neurology 71(2), 101-107 (2008).
95. Divekar A, Gaamangwe T, Shaikh N, Raabe M, Ducas J. Cardiac perforation after device closure of atrial septal defects with the Amplatzer septal occluder. J. Am. Coll. Cardiol. 45(8), 1213-1218 (2005). (Pubitemid 40523139)
96. Ries MW, Kampmann C, Rupprecht HJ, Hintereder G, Hafner G, Meyer J. Nickel release after implantation of the Amplatzer occluder. Am. Heart J. 145(4), 737-741 (2003). (Pubitemid 36403506)
97. Büscheck F, Sievert H, Kleber F et al. Patent foramen ovale using the Premere device: the results of the CLOSEUP trial. J. Interv. Cardiol. 19(4), 328-333 (2006). (Pubitemid 44185824)
98. Jones TK, Latson LA, Zahn E et al. Results of the U.S. multicenter pivotal study of the HELEX septal occluder for percutaneous closure of secundum atrial septal defects. J. Am. Coll. Cardiol. 49(22), 2215-2221 (2007). (Pubitemid 46830741)