PFO- To Close for Comfort. By: Vincent J.Caracciolo, MD FACC
|
|
- Jocelyn Lucas
- 5 years ago
- Views:
Transcription
1 PFO- To Close for Comfort By: Vincent J.Caracciolo, MD FACC
2 PATENT FORAMEN OVALE PFO- congenital lesion that frequently persists into adulthood ( 25-30%)- autopsy and TEE studies. PFO prevalence higher in cryptogenic stroke, especially < 55 years old. Cryptogenic Stroke- occurs in absence of cardioembolic or large vessel source with a distribution not c/w small vessel distibution. Cryptogenic stroke- 40% of all ischemic strokes in patients < 55 years old
3 PFO embryology Septum primum grows to endocardial cushions When cushions and septum primum meetperforations form this is foramen primum Perforations then fuse forming Foramen secundum ( oxygenated blood to go from RA to LA) This is effectively the Foramen ovale At birth- Flap closure- due to O2 filling alveoli cause pulm arterioles to open and decrease PVR( this increase LA pressure and reduces RA pressure)
4 Prevalence PFO ( Patent Foramen Ovale) Congenital Cardiac lesion 25-30% healthy hearts at autopsy Most are asymptomatic Stroke patients 26% had PFO found during TEE, >45 years of age Increased size of PFO in older patients
5
6
7 Other defects associated with PFO Interatrial septal Aneursym- ( ASA)- ( 0.2 to 2%) redundant mobile Interatrial septal tissue. Moves cm during cardiac-respiratory cycle- associated with PFOs Eustasian valve- juncture of IVC and RA Chiaria Network network of threads ad fibers in RA ( 2%)- strecth across RA from Eustacian valve attach to Interatrial septum
8 Inter-atrial septal aneursym
9 Atrial septal aneursym ( ASA) Increased prevalence in pts with thromboembolic CVA 8-15% 28% of CVA with normal carotid arteries Mecahnisms possible 1.) associated with PFO 2.)Fibrin- platelet particles adhere to LA side of aneursym and dislodge during ocillations
10
11 Eustacian Valve
12 Chiari Network
13 Cryptogenic Stroke ( CS) Absence of Cardiogenic emboli/large Vessel etiology/ distribution not c/w small vessel disease Increased risk of CS in patients with PFO Although PFO NOT associated with increased risk of RECURRENT stroke.
14 Cryptogenic Stroke
15
16 PFO and Stroke ( CS) Finding a PFO does NOT prove causal relationship Maybe innocent bystander ( 26% of all healthy hearts) Echo- start with transthoracic echo and then consider TEE/TCD with contrast TEE best- localize Flap Sedation may preclude adequate Valsalva- identify a PFO TCD only identify Right to left shunt shunt -not location of shunt
17 PFO and right to left shunting Can result in paradoxic embolus Transient increases in RA pressure- Valsalva Straining or Release phases- Defacate/Lifting/pushing heavy objects/ repetitive cough
18 Treatment of PFO Incidentally found PFO no follow up or treatment IF PFO is deemed causal to Cryptoigenic CVA- then medical therapy or closure of defect
19 Other clinical issues with PFO Migraine headache Decompression sickness Platypnea/orthodeoxia syndrome
20 WHAT is the DATA Isolated PFO- NOT associated with recurrent stroke Case Control Studies/meta analysis of them Increased risk of CVA if PFO, ASA or both in patients < 55 years old Odds ratio 3.1, 6.1, 15.6 Retrospective data risk of PFO and initial likelyhood of CVA History of Straining/hypercoaguable state/ multiple CVAs, Large PFO, Large right to left shunt, Spontaneous R to L shunt, PFO Flap mobility Another study showed no recurrent CVAs in a similar
21 Restrospective data Retrospective data PFO and initial risk of CVA History of Straining hypercoaguable state/ multiple CVAs Large PFO, Large right to left shunt, Spontaneous R to L shunt, PFO Flap mobility Prominent Eustasian valve or Chiari network Presence of Atrial Septal Aneursym
22 Prospective Studies Variable results French PFO- ASA study- 581 pts PICSS study- 630 pts CODICIA study- 486 patients NOMAS Study pts SPARC study
23 French PFO- ASA Study- 581 pts ( case control) < 55 years old ( mean 42) with Cryptogenic stroke 37% had PFO 1.7% had ASA 8.8% had both PFO and ASA All pts got Aspirin 300 mg a day Isolated ASA group at 4 years no recurrence of CVA Isolated PFO group-( regardless of size) no CVA at 4 years Both PFO and ASA- increased risk of CVA ( 15% vs 4% in the absence of these abnormalities
24 PICSS sudy- 630 pts- Ischemic CVA 42% were Cryptogenic CVA (case control) TEE showed that the CS patients higher incidence of PFO- 39% vs. 29% average age- 59 years old Assigned to receive ASA 325 mg a day vs warfarin for INR No association between PFO alone or PFO and ASA and recurrent risk of CVA or death ( different from French study) No reduction of recurrent CVA in pts on Warfarin vs. Aspirin
25 CODICIA study- 486 pts ( prospective) Transcranial Doppler quantify the magnitude of Right to left shunt- (RLSh) 2 year follow up, < 55 years old No association between magnitude of (RLSh) and recurrent CVA whether or not a Atrial Setpum aneursym was found or not
26 NOMAS STUDY 1100 patients (Prosepctive) Stroke free pts, > 40 years old Manhattan NY( mean age 69)- followed for about 6 years ( 80 months) TTE used to detect PFO PFO found in 14.9% patients ASA- 2.5% of pts. PFO alone or with ASA- statistically non-significant minor increased risk of CVA
27 SPARC study- 588 pts ( prosepctive) >45 years old, Olmstead Minnesoata- follow up- 5 years Used TEE- found 24% had PFO, 1.9% ASA PFO not significant risk for CVA after adjustment for comorbidities PFO size not associated with risk of CVA ASA 4 fold increase increase ( statistically not significant) only 11 pts had an ASA
28 Conclusions True risk of primary or recurrent ischemic Stroke associated with PFO or ASA difficult to estimate Case Control Trials- Association between Cryptogenic stroke and PFO- However 1/3 of all PFO found in Cryptogenic CVA are likely to be incidental findings Prospective trials PFO not associated with increased risk of recurrent CVA PFO + ASA- increased risk in French PFO/ASA study but not PICSS or CODICIA studies
29 2011 AHA/ASA guidelines PFO +/- ASA uncertain clinical importance in the development of first or recurrent CVA
30 Treatment for PFO/ASD and ASA for prevention of CVA 2011 AHA/ASA antiplatelet therapy is reasonable for cryptogenic CVA where no anticoagulation is necessary ( hypercoaguable patients) French PFO study- 216 pts with cryptogenic CVA + PFO Risk of recurrent CVA- 2.3% on Aspirin 300 mg qd Risk of recurrent CVA was 4.2% without PFO PFO + ASA- recurrent CVA- 15.2%- possible Warfarin or closure
31 PFO closure ( percutaneous vs surgical) No data on efficacy of closure on recurrent CVA Surgical closure- recurrent risk of CVA- 7-14% Sometimes residual shunt persists despite closure Lateral LA wall thrombus Increased atrial arrythmias with closure device
32
33 PC trial ( Amplatzer PFO occluder device) 414 pts (CS + PFO)-- < 60 year old PFO closure trials ( prospective/intention to treat) Closure 1 ( Starflex device) RESPECT 980 pts ( Amplatzer) ( CS + PFO_ = avg age- 46 years old 5 CVA vs 16 in the medical arm No statistically significant reduction in death/cva/tia When using intention to treat analyses but using raw data analysis it met statistical significance in CVA reduction alone ( p <.007%)
34 Starflex device
35 Amplatzer Septal Occluder device
36 TIA- 3.1 vs 4.1 % Closure 1 Trial Pts <60 with PFO + CS or TIA PFO closure (n= 447) vs med Rx (n= 462) Staflex PFO closure devise + ASA/Plavix x 6 months then ASA alone Med Rx- ASA or warfarin or both Endpoint CVA or TIA at 2 years No differences Combo of CVA/TIA ( 5.5 vs 6.8%) CVA- 2.9 vs 3.1%
37 Closure 1---subgroups Shunt size-- no differences in recurrent CVA ASA-- no differences Afib increased in PFO device arm 5.7% vs. 0% 5 of 12 strokes in Device arm- device thrombosis or afib related--??? Another devise could do better Critics feel study was underpowered and 2 year f/u not long enough ( i.e the CEA trials did not show benefit at 2 years) Suspicion that highest risk pts had closure outside the study
38 2012 ACCP guidelines Asymptomatic PFO or ASA NO antithrombotic therapy Incidental PFO and surgical closure may increase risk of post-op CVA PFO +/- ASA with cryptogenic CVA Aspirin If recurrent CVA on Aspirin or PFO + DVT then warfarin x 3 months then device closure vs. Aspirin
39 PFO with ASA (? Closure) French PFO/ASA study 51 pts ( < 55 years old) with Cryptogenic Stroke Recurrent CVA- 15.2% ( PFO+ ASA) on Aspirin Rx Suggest more aggresive therapy with Warfarin or closure BUT no difference in outcomes in the PICCS trial
40
41
42
I, (Issam Moussa) DO NOT have a financial interest/arrangement t/ t or affiliation with one or more organizations that could be perceived as a real
PFO Closure: Where We Are Going to after CLOSURE I Study? Issam D. Moussa, MD Professor of Medicine Chair, Division of Cardiovascular Diseases Mayo Clinic Jacksonville, Florida Disclosure Statement of
More informationCryptogenic Stroke: What Don t We Know. Siddharth Sehgal, MD Medical Director, TMH Stroke Center Tallahassee Memorial Healthcare
Cryptogenic Stroke: What Don t We Know Siddharth Sehgal, MD Medical Director, TMH Stroke Center Tallahassee Memorial Healthcare Financial Disclosures None Objectives Principles of diagnostic evaluation
More informationPFO (Patent Foramen Ovale): Smoking Gun or an Innocent Bystander?
PFO (Patent Foramen Ovale): Smoking Gun or an Innocent Bystander? J Thompson Sullebarger, M.D. Florida Cardiovascular Institute University of South Florida Kris Letang Tedy Bruschi Bret Michaels The Atrial
More informationPatent Foramen Ovale: Diagnosis and Treatment
Patent Foramen Ovale: Diagnosis and Treatment Anthony DeMaria Judy and Jack White Chair in Cardiology University of California, San Diego At one time or another a Grantee, Sponsored Speaker or Ad-hoc Consultant
More information2017 Cardiovascular Symposium CRYPTOGENIC STROKE: A CARDIOVASCULAR PERSPECTIVE DR. WILLIAM DIXON AND DR. VENKATA BAVAKATI SOUTHERN MEDICAL GROUP, P.A.
CRYPTOGENIC STROKE: 2017 Cardiovascular Symposium A CARDIOVASCULAR PERSPECTIVE DR. WILLIAM DIXON AND DR. VENKATA BAVAKATI SOUTHERN MEDICAL GROUP, P.A. CRYPTOGENIC STROKE CRYPTOGENIC: OF OBSCURE OR UNKNOWN
More informationAntithrombotic Summit Basel 2012 Basel, 26. April Peter T. Buser Klinik Kardiologie Unviersitätsspital Basel
Antithrombotic Summit Basel 2012 Basel, 26. April 2012 Peter T. Buser Klinik Kardiologie Unviersitätsspital Basel Background stroke = third-leading cause of death among adults 1/5 of stroke survivors require
More informationPFO Management update
PFO Management update May 12, 2017 Peter Casterella, MD Swedish Heart and Vascular 1 PFO Update 2017: Objectives Review recently released late outcomes of RESPECT trial and subsequent FDA approval of PFO
More informationPatent foramen ovale (PFO) is composed of
PFO Closure for Prevention of Recurrent Cryptogenic Stroke The evidence base is here. BY JOHN F. RHODES, JR, MD Patent foramen ovale (PFO) is composed of overlapping portions of septum primum and septum
More informationWhy Treat Patent Forman Ovale
Why Treat Patent Forman Ovale Clifford J Kavinsky, MD, PHD Professor of Medicine and pediatrics Associate Director, Center for Congenital and Structural Heart Disease Rush University Medical Center Conclusions
More informationRahul Jhaveri, M.D. The Heart Group of Lancaster General Health
Rahul Jhaveri, M.D. The Heart Group of Lancaster General Health INTRODUCTION Three recently published randomized controlled trials in The New England Journal of Medicine provide new information about closure
More informationWhy Should We Treat PFO?
Why Should We Treat PFO? SCAI Interventional Cardiology Fellows Course December 7, 2012 Jonathan Tobis, MD Director of Interventional Cardiology UCLA Disclosures Jonathan Tobis, MD 1. A Principal Investigator
More informationDevices for Stroke Prevention. Douglas Ebersole, MD Interventional Cardiology Watson Clinic LLP
Devices for Stroke Prevention Douglas Ebersole, MD Interventional Cardiology Watson Clinic LLP Overview Left Atrial Appendage Closure FDA Approved Watchman Investigational Amulet PFO Closure Atrial Fibrillation
More informationStroke and ASA / FO REBUTTAL
REBUTTAL Definition of an ischemic stroke Definition of a PFO Evidence for a causal role of PFO in stroke Evidence against a role of PFO in stroke Stroke recurrencies in stroke (PFO) patients Medical treatment
More informationDEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE. Matthew Starr, MD Stroke Attending
DEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE Matthew Starr, MD Stroke Attending DISCLOSURES None DEBATE Should PFO be closed? * * Sometimes yes THE CASE AGAINST PFO CLOSURE 1. Did the PFO cause the
More informationCryptogenic Stroke/PFO with Thrombophilia and VTE: Do We Know What To Do?
Cryptogenic Stroke/PFO with Thrombophilia and VTE: Do We Know What To Do? Robert J. Sommer, MD Columbia University Medical Center New York, NY Disclosure Statement of Financial Interest Within the past
More informationGERIATRICS CASE PRESENTATION
GERIATRICS CASE PRESENTATION CASE 79 year old Patient X was admitted to hospital with SOB. He had a hx of sarcoidosis and asbestosis. Home oxygen requirement is 3-3.5litre. He was admitted, given ceftriaxone
More informationPERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE AND ATRIAL SEPTAL DEFECT: STATE OF THE ART AND A CRITICAL APPRAISAL
PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE AND ATRIAL SEPTAL DEFECT: STATE OF THE ART AND A CRITICAL APPRAISAL Carmelo Cernigliaro Clinica San Gaudenzio Novara Eco 2D e 3D Eco Transesofageo Large shunt
More informationΣΥΓΚΛΕΙΣΗ ΑΝΟΙΚΤΟΥ ΩΟΕΙΔΟΥΣ ΤΡΗΜΑΤΟΣ ΠΕΣΡΟ. ΔΑΡΔΑ, MD, FESC 33 Ο Πανελλήνιο Καρδιολογικό Συνζδριο ΑΘΗΝΑ 2012
ΣΥΓΚΛΕΙΣΗ ΑΝΟΙΚΤΟΥ ΩΟΕΙΔΟΥΣ ΤΡΗΜΑΤΟΣ 2012 ΠΕΣΡΟ. ΔΑΡΔΑ, MD, FESC 33 Ο Πανελλήνιο Καρδιολογικό Συνζδριο ΑΘΗΝΑ 2012 The Problem: Not All PFO in Patients With Cryptogenic Stroke is Pathogenic; No Definitive
More informationMigraine and Patent Foramen Ovale (PFO)
Migraine and Patent Foramen Ovale (PFO) Hans-Christoph Diener Senior Professor of Clinical Neurosciences Department of Neurology and Headache Center University Essen Topics Prevalence of PFO Is migraine
More informationPatent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS
Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS 11-8-18 Outline 1. Background 2. Anatomy of patent foramen ovale (PFO) 3. Relationship between PFO and
More informationFabien Praz, Andreas Wahl, Sophie Beney, Stephan Windecker, Heinrich P. Mattle*, Bernhard Meier
Procedural Outcome after Percutaneous Closure of Patent Foramen Ovale using the Amplatzer PFO Occluder Without Intra-Procedural Echocardiography in 1,000 Patients Fabien Praz, Andreas Wahl, Sophie Beney,
More informationThe Patent Foramen Ovale A Preventable Stroke Etiology?! Brian Whisenant, M.D.
The Patent Foramen Ovale A Preventable Stroke Etiology?! Brian Whisenant, M.D. Conflict of Interest Statement I have a financial interest in Coherex Medical. Heart Disease and Stroke Statistics 2008 Update:
More informationΓεώργιος Δ. Κατσιμαγκλής. Αν. Διευθυντής Καρδιολογικής ΚλινικήςΝΝΑ Διευθυντής Αιμοδυναμικού Εργαστηρίου ΝΝΑ
Γεώργιος Δ. Κατσιμαγκλής Αν. Διευθυντής Καρδιολογικής ΚλινικήςΝΝΑ Διευθυντής Αιμοδυναμικού Εργαστηρίου ΝΝΑ I have no disclosures ΣΥΧΝΟΤΗΤΑ An atrial septal defect (ASD) is a deficiency of the atrial septum.
More informationPATENT FORAMEN OVALE: UPDATE IN MANAGEMENT OF RECURRENT STROKE KATRINE ZHIROFF, MD, FACC, FSCAI LOS ANGELES CARDIOLOGY ASSOCIATES
PATENT FORAMEN OVALE: UPDATE IN MANAGEMENT OF RECURRENT STROKE KATRINE ZHIROFF, MD, FACC, FSCAI LOS ANGELES CARDIOLOGY ASSOCIATES OBJECTIVES Review social burden and epidemiology of stroke Gender disparities
More informationCurrent management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale
Review Article Current management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale Kaivan Vaidya 1,2, Chinmay Khandkar 1,2, David Celermajer 1,2 1 Department of Cardiology,
More informationBASIL D. THANOPOULOS MD, PhD Associate Professor Honorary Consultant, RBH, London, UK
TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO BASIL D. THANOPOULOS MD, PhD Associate Professor Honorary Consultant, RBH, London, UK TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO BASIL D.
More informationEAE RECOMMENDATIONS FOR TRANSESOPHAGEAL ECHO. Cardiac Sources of Embolism. Luigi P. Badano, MD, FESC
EAE RECOMMENDATIONS FOR TRANSESOPHAGEAL ECHO. Cardiac Sources of Embolism Luigi P. Badano, MD, FESC Background Stroke is the 3 cause of death in several industrial countries; Embolism accounts for 15-30%
More informationCryptogenic Stroke: A logical approach to a common clinical problem
Cryptogenic Stroke: A logical approach to a common clinical problem Alphonse M. Ambrosia, DO, FACC Interventional Cardiologist CardioVascular Associates of Mesa Mesa, Arizona Speakers Bureau Boston Scientific
More informationA 29-Year-Old Man With Acute Onset Blurry Vision, Weakness, and Gait Abnormality
Clinical Case of the Month A 29-Year-Old Man With Acute Onset Blurry Vision, Weakness, and Gait Abnormality Deepu Thoppil, MD; Murtuza J. Ali, MD; Neeraj Jain, MD; Sanjay Kamboj, MD; Pramilla Subramaniam,
More informationCLOSE. Closure of Patent Foramen Ovale, Oral anticoagulants or Antiplatelet Therapy to Prevent Stroke Recurrence
CLOSE Closure of Patent Foramen Ovale, Oral anticoagulants or Antiplatelet Therapy to Prevent Stroke Recurrence Guillaume TURC, MD, PhD Paris Descartes University Sainte-Anne hospital Paris, France On
More informationACUTE CENTRAL PERIFERALEMBOLISM
EAE TEACHING COURSE 2010 Belgrade, Serbia October 22-23, 2010 ACUTE CENTRAL and PERIFERALEMBOLISM Maria João Andrade Lisbon, PT BACKGROUND Stroke is a leading cause of mortality and long-term disability
More informationManagement and Investigation of Ischemic Stroke By Etiology
Management and Investigation of Ischemic Stroke By Etiology Andrew M. Demchuk MD FRCPC Director, Calgary Stroke Program Deputy Dept Head, Clinical Neurosciences Heart and Stroke Foundation Chair in Stroke
More informationDescription. Page: 1 of 23. Closure Devices for Patent Foramen Ovale and Atrial Septal Defects. Last Review Status/Date: December 2014
Last Review Status/Date: December 2014 Page: 1 of 23 Description Background Patent Foramen Ovale The foramen ovale, a component of fetal cardiovascular circulation, consists of a communication between
More informationPercutaneous closure of a patent foramen ovale after cryptogenic stroke
Neth Heart J (2018) 26:5 12 https://doi.org/10.1007/s12471-017-1063-3 POINT OF VIEW Percutaneous closure of a patent foramen ovale after cryptogenic stroke R. J. R. Snijder 1 M.J.Suttorp 1 J.M.tenBerg
More informationCPAG Summary Report for Clinical Panel Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke
MANAGEMENT IN CONFIDENCE CPAG Summary Report for Clinical Panel Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke The Benefits of the Proposition Percutaneous Patent Foramen Ovale
More informationEffect of Having a PFO Occlusion Device in Place in the RESPECT PFO Closure Trial
Effect of Having a PFO Occlusion Device in Place in the RESPECT PFO Closure Trial DAVID E. THALER, MD, PHD, JEFFREY L. SAVER, MD RICHARD W. SMALLING, MD, PHD, JOHN D. CARROLL, MD, SCOTT BERRY, PHD, LEE
More informationDisclosure. Consultation: Rimed, Philips Healthcare Research: Philips Healthcare
Zsolt Garami, MD Transcranial Doppler Bubble Test for PFO (Does the saline solution or body position matter?) Methodist DeBakey Heart and Vascular Center, The Methodist Hospital Research Institute, The
More informationRESPECT Safety Findings
CO-1 SCAI Town Hall Meeting Monday, October 31, 2016 Washington, DC RESPECT Safety Findings John D. Carroll, M.D., MSCAI Professor of Medicine Cardiology University of Colorado School of Medicine University
More informationCryptogenic Strokes: Evaluation and Management
Cryptogenic Strokes: Evaluation and Management 77 yo man with hypertension and hyperlipidemia developed onset of left hemiparesis and right gaze preference, last seen normal at 10:00 AM Brought to ZSFG
More informationAntithrombotic therapy for patients with congenital heart disease. George Giannakoulas, MD, PhD AHEPA University Hospital Thessaloniki
Antithrombotic therapy for patients with congenital heart disease George Giannakoulas, MD, PhD AHEPA University Hospital Thessaloniki Disclosures Educational fees from Astra Zeneca, GSK Research fees from
More informationTranscatheter Closure of Septal Defects
Transcatheter Closure of Septal Defects Policy Number: 2.02.09 Last Review: 11/2018 Origination: 3/2007 Next Review: 11/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage
More informationTranscatheter closure of patent foramen ovale using the internal jugular venous approach
New methods in diagnosis and therapy Transcatheter closure of patent foramen ovale using the internal jugular venous approach Przemysław Węglarz 1,2, Ewa Konarska-Kuszewska 2, Tadeusz Zębik 2, Piotr Kuszewski
More informationTRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO
TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO BASIL D. THANOPOULOS MD, PhD Associate Professor Agios Loukas Clinic, Thessaloniki, Greece Ares Heart Center, Bucharest, Romania Honorary Consultant,
More informationEchocardiography Conference
Echocardiography Conference David Stultz, MD Cardiology Fellow, PGY-6 September 20, 2005 Atrial Septal Aneurysm Bulging of Fossa Ovalis Associated commonly with Atrial septal defect or small perforations
More informationPFO Closure for the Management of Migraine and Stroke
PFO Closure for the Management of Migraine and Stroke Sun U. Kwon Department of Neurology, Asan Medical Center, UUMC Contents PFO & Migraine PFO causes Migraine or Not? PFO closure for Migraine PFO & Stroke
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute ischemic stroke TOAST classification of, 270 Acute myocardial infarction (AMI) cardioembolic stroke following, 207 208 noncardioembolic
More informationAVC Criptogénico: Está na altura de alterar as guidelines? Claudia Jorge University Hospital of Santa Maria
Está na altura de alterar as guidelines? Claudia Jorge University Hospital of Santa Maria Está na altura de alterar as guidelines? Está na altura de alterar as guidelines? ~25% of all ischemic strokes
More informationPFO closure group total no. PFO closure group no. of males
Suppl Table. Characteristics of the five trials included in this meta-analysis. Trial name Device used for Definition of medical Primary Endpoint group total no. group no. of males group age (yrs) group
More informationThe Relation of Migraine Headaches and Interatrial Shunts
PFO AND MIGRAINE HOSPITAL CHRONICLES 2006, SUPPLEMENT: 73 78 CARDIOLOGY UPDATE 2006 The Relation of Migraine Headaches and Interatrial Shunts Konstantinos G. Kappos, MD, Vassiliki Tsagou, MD, George Andrikopoulos,
More information2D/3D in Evaluation of Atrial Septum
2D/3D in Evaluation of Atrial Septum Roberto M Lang, MD OSTIUM SECUNDUM ASD: 2D AND 3D TNSESOPHAGEAL ECHO 1 Biplane views 90 0 3D Acquisi on Acquire 3D volume Lang RM et al. JASE 2012;25:3 46. Right atrial
More informationTranscatheter Closure of Cardiovascular Defects
Medical Coverage Policy Effective Date...11/15/2017 Next Review Date...11/15/2018 Coverage Policy Number... 0011 Transcatheter Closure of Cardiovascular Defects Table of Contents Related Coverage Resources
More informationCLINICAL FEATURES THAT SUPPORT ATHEROSCLEROTIC STROKE 1. cerebral cortical impairment (aphasia, neglect, restricted motor involvement, etc.) or brain stem or cerebellar dysfunction 2. lacunar clinical
More informationStroke is the third leading cause of death in the United
Cryptogenic Stroke in Patients with Patent Foramen Ovale Carlos E. Sanchez, MD, Joo A. Lee, MD, Geoffrey Eubank, MD, and Steven J. Yakubov, MD Abstract Objective: To discuss what is known regarding patent
More informationEchocardiography in Systemic Embolization. January 29, 2007 Joe M. Moody, Jr, MD UTHSCSA and STVHCS
Echocardiography in Systemic Embolization January 29, 2007 Joe M. Moody, Jr, MD UTHSCSA and STVHCS Neurologic Events and Cardiac Source of Embolus For patients who present with evidence of abrupt arterial
More informationPRACTICAL NEUROLOGY. An endovascular device to close a patent foramen ovale: b. Patent foram Blackwell Publishing Ltd
4 PRACTICAL NEUROLOGY Patent foram An endovascular device to close a patent foramen ovale: b FEBRUARY 2003 5 Jean-Louis Mas Service de Neurologie, Hôpital Sainte-Anne, 1 rue Cabanis, 75674 Paris Cedex
More informationAnaesthesia for percutaneous closure of atrial septal defects Patrick A Calvert BCh MA MRCP Andrew A Klein MBBS FRCA
Anaesthesia for percutaneous closure of atrial septal defects Patrick A Calvert BCh MA MRCP Andrew A Klein MBBS FRCA Key points Percutaneous closure is the procedure of choice for the majority of patients
More informationAtrial Septal Defect Closure. Stephen Brecker Director, Cardiac Catheterisation Labs
Stephen Brecker Director, Cardiac Catheterisation Labs ADVANCED ANGIOPLASTY Incorporating The Left Main 5 Plus Course Conflicts of Interest The following companies have supported educational courses held
More informationTrue cryptogenic stroke
True cryptogenic stroke Arne Lindgren, MD, PhD Dept of Clinical Sciences Lund, Neurology, Lund University Dept of Neurology and Rehabilitation Medicine Skåne University Hospital Lund, Sweden Disclosures
More informationIs Stroke a Paradoxical Embolism in Patients with Patent Foramen Ovale?
ORIGINAL ARTICLE Is Stroke a Paradoxical Embolism in Patients with Patent Foramen Ovale? Masahiro YASAKA, Ryoichi OTSUBO, Hiroshi OE and Kazuo MINEMATSU Abstract Objective Purpose was to assess the stroke
More informationPFO CLOSURE: WHAT S NEW?
PFO CLOSURE: WHAT S NEW? 1. AHA rescinds major sections of 2018 AHA/ASA Stroke Guidelines 2. PFO closure is cost effective 3. Now 12 meta-analyses of PFO/Stoke RCT confirm PFO closure superiority 4. FDA
More informationPractice Parameter: Recurrent Stroke With Patent Foramen Ovale and Atrial Septal Aneurysm
Practice Parameter: Recurrent Stroke With Patent Foramen Ovale and Atrial Septal Aneurysm Report of the Quality Standards Subcommittee of the American Academy of Neurology* S.R. Messé, MD; I.E. Silverman,
More informationTranscatheter Closure of Septal Defects
Transcatheter Closure of Septal Defects Policy Number: 2.02.09 Last Review: 11/2017 Origination: 3/2007 Next Review: 11/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage
More informationIn October 2016, the US Food and Drug Administration
The Approval of PFO Closure in the United States A look back at the long road to FDA approval and the implications on patient care options going forward. By Marie-France Poulin, MD, and Clifford J. Kavinsky,
More informationCEREBRO VASCULAR ACCIDENTS
CEREBRO VASCULAR S MICHAEL OPONG-KUSI, DO MBA MORTON CLINIC, TULSA, OK, USA 8/9/2012 1 Cerebrovascular Accident Third Leading cause of deaths (USA) 750,000 strokes in USA per year. 150,000 deaths in USA
More informationUptofate Study Summary
CONGENITAL HEART DISEASE Uptofate Study Summary Acyanotic Atrial septal defect Ventricular septal defect Patent foramen ovale Patent ductus arteriosus Aortic coartation Pulmonary stenosis Cyanotic Tetralogy
More informationPFO Closure is a Therapy for Migraine PRO
PFO Closure is a Therapy for Migraine PRO Andrew Charles, M.D. Professor Director, UCLA Goldberg Migraine Program Meyer and Renee Luskin Chair in Migraine and Headache Studies Director, Headache Research
More informationIschemic stroke: management, prevention and follow up. Amit Kansara MD Providence Stroke Center Providence Brain and Spine Institute
Ischemic stroke: management, prevention and follow up Amit Kansara MD Providence Stroke Center Providence Brain and Spine Institute Quotes Benjamin Franklin: All would live long, but none would be old.
More informationGlenmark Cardiac Centre Mumbai, India
ASD device closure: Long term follow up Bharat Dalvi, MD Glenmark Cardiac Centre Mumbai, India Our experience 1998 to 2011 1566 patients 912 patients > 4 years FU Exclusive with ASO Clinical, electrocardiographic
More informationAtrial Septal Defects
Supplementary ACHD Echo Acquisition Protocol for Atrial Septal Defects The following protocol for echo in adult patients with atrial septal defects (ASDs) is a guide for performing a comprehensive assessment
More informationSupplementary webappendix
Supplementary webappendix This webappendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Hart RG, Diener H-C, Coutts SB, et al,
More informationPatent Foramen Ovale Closure Using a Bioabsorbable Closure Device
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 3, NO. 9, 2010 2010 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2010.06.012 Patent Foramen
More informationHow Can We Properly Manage Patients With Stroke of Undetermined Origin?
How Can We Properly Manage Patients With Stroke of Undetermined Origin? : Spotlight on Embolic Stroke of Undetermined Source (ESUS) MI SUN OH Department of Neurology, Hallym University Scared Heart Hospital,
More informationQualifying and Outcome Strokes in the RESPECT PFO Trial: Additional Evidence of Treatment Effect
Qualifying and Outcome Strokes in the RESPECT PFO Trial: Additional Evidence of Treatment Effect JEFFREY L. SAVER, MD DAVID E. THALER, MD, PHD, RICHARD W. SMALLING, MD, PHD, JOHN D. CARROLL, MD, SCOTT
More informationCryptogenic Stroke and Migraine Headache: The Clinical Cardiologist s View
CRYPTOGENIC STROKE, MIGRAINE & PFO HOSPITAL CHRONICLES 2006, SUPPLEMENT: 67 72 CARDIOLOGY UPDATE 2006 Cryptogenic Stroke and Migraine Headache: The Clinical Cardiologist s View Harold L. Kennedy, MD A
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of percutaneous closure of patent foramen ovale for the secondary prevention
More informationRoles and Effective of Foramen Ovale Closure to Prevent Recurrent Stroke
Roles and Effective of Foramen Ovale Closure to Prevent Recurrent Stroke 1 Saeed Abdulrahman Alghamdi, 2 Abdullah Abdulrahman Alghamdi, 3 Saeed Abdulaziz Alghamdi, 4 Eid Hussein Alshahrani, 5 Alwaleed
More informationSixth Annual Intensive Update in Neurology 9/15-16/2016. W Tom Kushner DO Swedish Stroke Clinic Neurohospitalist
W Tom Kushner DO Swedish Stroke Clinic Neurohospitalist 1 One Strategy for cryptogenic stroke: ESUS Positively defined criteria FDA allows clinical trials NOACs have lower risk profile Another strategy
More informationAdvances in Prevention and Treatment of Stroke: What Every Primary Care Physician Needs to Know. Case 1 4/5/11. What treatment should you initiate?
Advances in Prevention and Treatment of Stroke: What Every Primary Care Physician Needs to Know S. Andrew Josephson, MD Director, Neurohospitalist Program Medical Director, Inpatient Neurology University
More informationΔΙΑΧΕΙΡΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΜΕΣΟΚΟΛΠΙΚΗ ΕΠΙΚΟΙΝΩΝΙΑ ΖΑΧΑΡΑΚΗ ΑΓΓΕΛΙΚΗ ΚΑΡΔΙΟΛΟΓΟΣ ΗΡΑΚΛΕΙΟ - ΚΡΗΤΗ
ΔΙΑΧΕΙΡΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΜΕΣΟΚΟΛΠΙΚΗ ΕΠΙΚΟΙΝΩΝΙΑ ΖΑΧΑΡΑΚΗ ΑΓΓΕΛΙΚΗ ΚΑΡΔΙΟΛΟΓΟΣ ΗΡΑΚΛΕΙΟ - ΚΡΗΤΗ European Accreditation in TTE, TEE and CHD Echocardiography NOTHING TO DECLARE ATRIAL SEPTAL DEFECT TYPES SECUNDUM
More informationPathophysiology: Left To Right Shunts
Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature
More informationA challenging case of successful ASD closure without echocardiographic guidance in an 86-year old with severe kyphoscoliosis and platypnoeaorthodeoxia
A challenging case of successful ASD closure without echocardiographic guidance in an 86-year old with severe kyphoscoliosis and platypnoeaorthodeoxia syndrome. Dr Anvesha Singh, Dr James Ogle, Dr Derek
More informationDental Management Considerations for Patients on Antithrombotic Therapy
Dental Management Considerations for Patients on Antithrombotic Therapy Warfarin and Antiplatelet Joel J. Napeñas DDS FDSRCS(Ed) Program Director General Practice Residency Program Department of Oral Medicine
More informationIt has been 133 years since the German anatomist J.
PFO Closure to Prevent Recurrent TIA and Stroke What is the evidence base for patent foramen ovale closure? BY MICHAEL H. SALINGER, MD, FACC, FSCAI; MEHMET CILINGIROGLU, MD, FACC, FESC, FSCAI; JUSTIN P.
More informationClinical Policy: Transcatheter Closure of Patent Foramen Ovale Reference Number: CP.MP.151
Clinical Policy: Reference Number: CP.MP.151 Effective Date: 12/17 Last Review Date: 12/17 See Important Reminder at the end of this policy for important regulatory and legal information. Coding Implications
More informationINSTRUCTIONS FOR USE FOR:
INSTRUCTIONS FOR USE FOR: en English bg INSTRUCTIONS FOR USE FOR: GORE CARDIOFORM SEPTAL OCCLUDER Carefully read all instructions prior to use. Observe all warnings and precautions noted throughout these
More informationIn 1877, Cohnheim performed a
CLINICIAN UPDATE Contemporary Management of Patent Foramen Ovale Bernhard Meier, MD; James E. Lock, MD In 1877, Cohnheim performed a necropsy on a young woman who had died from a stroke. He hypothesized
More informationPathophysiology: Left To Right Shunts
Pathophysiology: Left To Right Shunts Daphne T. Hsu, MD dh17@columbia.edu Learning Objectives Learn the relationships between pressure, blood flow, and resistance Review the transition from fetal to mature
More informationStroke Case Studies. Dr Stuti Joshi Neurology Advanced Trainee Telestroke fellow
Stroke Case Studies Dr Stuti Joshi Neurology Advanced Trainee Telestroke fellow Case 1 64 year old female with dysphasia and right arm weakness 3 hours prior CT head: dense M1 sign. No established ischaemia
More informationBubble contrast echocardiogram (echo)
Page 1 of 5 Bubble contrast echocardiogram (echo) Introduction This leaflet has been written to inform you about your planned bubble contrast echocardiogram. What is a bubble contrast echocardiogram? An
More informationMEET 2007: Evaluation and treatment of the stroke and TIA patient for the non-neurointerventionist. neurointerventionist
MEET 2007: Evaluation and treatment of the stroke and TIA patient for the non-neurointerventionist neurointerventionist Steve Ramee, MD Ochsner Medical Center New Orleans DISCLOSURE Nothing Nothing to
More informationCANADIAN STROKE BEST PRACTICE RECOMMENDATIONS. Prevention of Stroke Evidence Tables Cardiac Issues
CANADIAN STROKE BEST PRACTICE RECOMMENDATIONS Cardiac Issues Wein T, Gladstone D (Writing Group Chairs) on Behalf of the PREVENTION of STROKE Writing Group 2017 Heart and Stroke Foundation September 2017
More informationEvidence Based Stroke Update Ajay Bhalla Guy s and St Thomas Hospitals UK Stroke Forum
Evidence Based Stroke Update 2017 Ajay Bhalla Guy s and St Thomas Hospitals UK Stroke Forum Future is hard to predict.. Future is hard to predict.. Future is hard to predict.. Future is hard to predict..
More informationManagement of cervicocephalic arterial dissection. Ciro G. Randazzo, MD, MPH Thomas Jefferson University Hospital, Department of Neurosurgery
Management of cervicocephalic arterial dissection Ciro G. Randazzo, MD, MPH Thomas Jefferson University Hospital, Department of Neurosurgery Definition Disruption of arterial wall, either at level of intima-media
More informationPatent foramen ovale morphology and stroke size
Priority Paper evaluation Patent foramen ovale morphology and stroke size Evaluation of: Akhondi A, Gevorgyan R, Tseng CH et al.: The Association of patent foramen ovale morphology and stroke size in patients
More informationWatchman and Structural update..the next frontier. Ari Chanda, MD Cardiology Associates of Fredericksburg
Watchman and Structural update..the next frontier Ari Chanda, MD Cardiology Associates of Fredericksburg Different Left Atrial Appendage (LAA) morphologies Watchman (the device) Fabric Anchors Device structure
More informationDevice Closure of ASD in Children Using the Amplatzer Devices: Indications and catheter preparations, technique, and outcome [15]
Device Closure of ASD in Children Using the Amplatzer Devices: Indications and catheter preparations, technique, and outcome [15] SCAI Fellow Course Fall 2014 Ralf J Holzer MD MSc FSCAI Medical Director
More informationCorporate Medical Policy
Corporate Medical Policy Congenital Heart Defect, Repair Devices File Name: Origination: Last CAP Review: Next CAP Review: Last Review: congenital_heart_defect_repair_devices 10/2000 6/2017 6/2018 6/2017
More informationThe ABCs of PFOs and ASDs. John M. Lasala MD PhD Director of Adult Structural Heart Disease Washington University
The ABCs of PFOs and ASDs John M. Lasala MD PhD Director of Adult Structural Heart Disease Washington University Disclosure Consultant, Proctor AGA /St. Jude Medical The PFO / Stroke Story >2,400 yrs-ago
More informationFORAME OVALE PERVIO E ICTUS CRIPTOGENETICO: Dimensione del problema. Roberto Mantovan, MD, PhD U.O. Cardiologia Ospedale M.
FORAME OVALE PERVIO E ICTUS CRIPTOGENETICO: Dimensione del problema Roberto Mantovan, MD, PhD U.O. Cardiologia Ospedale M. Bufalini - Cesena FORAME OVALE PERVIO ICTUS CRIPTOGENETICO FORAME OVALE PERVIO
More information2018 Update in Diagnosis and Management of Stroke
2018 Update in Diagnosis and Management of Stroke S. Andrew Josephson MD Carmen Castro Franceschi and Gladyne K. Mitchell Neurohospitalist Distinguished Professor Chair, Department of Neurology Director,
More information