Patent Foramen Ovale Closure for Stroke, Myocardial Infarction, Peripheral Embolism, Migraine, and Hypoxemia

Cover
Patent Foramen Ovale Closure for Stroke, Myocardial Infarction, Peripheral Embolism, Migraine, and Hypoxemia
Copyright
Contributors
Preface
Acknowledgments
Part I: Introduction
1 - Embryology, Anatomy, and Physiology: Anatomical Variations, Lipomatous Hypertrophy, Atrial Septal Aneurysm, Eus ...
	INTRODUCTION
		PFO Embryology
		PFO Anatomy
	PRENATAL CIRCULATION—ROLE OF THE FORAMEN OVALE
	POSTNATAL CIRCULATION
	PERSISTENCE OF PFO AND ITS CONSEQUENCES
	ANATOMIC VARIATIONS AND CLINICAL IMPORTANCE
	LIPOMATOUS HYPERTROPHY AND CLINICAL IMPLICATIONS
	ATRIAL SEPTAL ANEURYSM (ASA)
	EUSTACHIAN VALVE AND CHIARI NETWORK
	COMBINATION WITH OTHER ATRIAL SEPTAL DEFECTS
	CONCLUSION
	References
Part II: Diagnosis and Imaging Assessment of PFO
2 - Echocardiography, Transcranial Doppler, and Oximetry for Imaging and Quantification of PFO-Mediated Shunts
	INTRODUCTION
	ULTRASOUND DETECTION OF A PFO
	CONTRAST AGENT DURING A BUBBLE STUDY
	INJECTION SITE FOR A BUBBLE STUDY (ANTECUBITAL VS. FEMORAL)
	PROVOCATION MANEUVERS DURING A BUBBLE STUDY
	DIAGNOSTIC CRITERIA FOR INTRACARDIAC RIGHT-TO-LEFT SHUNT
	TRANSTHORACIC ECHOCARDIOGRAPHY FOR THE DIAGNOSIS OF PFO
		Protocol for a Transthoracic Echocardiography Bubble Study
		Diagnostic Accuracy of Transthoracic Echocardiography Bubble Study
		Advantages and Limitations of Transthoracic Echocardiography for Detecting a PFO
	TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR THE DIAGNOSIS OF PFO
		Protocol for a Transesophageal Echocardiography Bubble Study
		Diagnostic Accuracy of Transesophageal Echocardiography Bubble Study
		Advantages and Limitations of Transesophageal Echocardiography for Detecting a PFO
	TRANSCRANIAL DOPPLER FOR THE DIAGNOSIS OF PFO
		Protocol for a Transcranial Doppler Bubble Study
		Diagnostic Accuracy of Transcranial Doppler Bubble Study
		Advantages and Limitations of Transcranial Doppler for Detecting a PFO
	INTRACARDIAC ECHOCARDIOGRAPHY FOR THE DIAGNOSIS OF PFO
	ANGIOGRAPHIC ASSESSMENT OF PFO AND ITS CHARACTERISTICS
	EAR OXIMETRY FOR THE DIAGNOSIS OF PFO
	CARDIAC COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF PFO
	MAGNETIC RESONANCE IMAGING FOR THE DIAGNOSIS OF PFO
	CONCLUSIONS AND RECOMMENDATIONS
	SUPPLEMENTARY MATERIALS
	References
Part III: Stroke and PFO
3 - Angiography, Transthoracic, Transesophageal, and Intracardiac Echocardiography: Periprocedural Assessment and G ...
	INTRODUCTION
	IMAGING STAGES
		Preprocedural Imaging
			Screening
			Assessing and Characterizing the PFO
			Device Selection
		Procedural Guidance
			Angiography
		Postprocedural Assessment of Device Position
		Follow-Up Imaging
		Special Situations
			Role of Intracardiac Echocardiography
			PFO Closure Without Prior (Transesophageal) Echocardiography
			In-Hospital Complications
				Air Aspiration or Air Embolism
				Device Residing Partially in the Tunnel of the PFO
			PFO Occluder Embolization
		Reclosure in Case of a Significant Residual Shunt [9]
		PFO Closure after Left Atrial Appendage Occlusion
		Left Atrial Ablation, Left Atrial Appendage Closure, or Other Left Atrial Catheter Intervention after PFO Closure
	SUPPLEMENTARY MATERIALS
	References
4 - Definition of Cryptogenic Stroke, the RoPE Score, and Assessment of Embolic Stroke of Undetermined Source
	INTRODUCTION
	THE ROPE STUDY
	ROPE SCORE VALIDATION
	ROPE SCORE ADJUSTED FOR ANATOMICAL–FUNCTIONAL PFO FEATURES
	EMBOLIC STROKE OF UNDETERMINED SOURCE
	CONCLUSION
	References
5 - Observational Studies of PFO Closure for Stroke
	INTRODUCTION
	OBSERVATIONAL STUDIES
		Pathophysiologic Relationship of Systemic Embolism and Stroke with PFO
		Observational Studies of Medical Therapy for PFO Associated Stroke
		Observational Studies of PFO Closure for Stroke
		Meta-Analysis of Observational Studies of PFO Closure for Stroke
	CONCLUSIONS
	References
6 - Early Randomized Trials of PFO Closure for Stroke (CLOSURE I, PC and RESPECT)
	INTRODUCTION
	THE CLOSURE I PFO TRIAL
	THE PC TRIAL
	THE RESPECT TRIAL
		Early Follow-Up of the RESPECT Trial
		Long-Term Follow-up of the RESPECT Trial
	A COMMON LIMITATION OF ALL THE EARLY RANDOMIZED TRIALS
	META-ANALYSES OF THE EARLY TRIALS OF PFO CLOSURE FOR STROKE
	FDA APPROVAL OF PERCUTANEOUS PFO CLOSURE FOR STROKE
	CONCLUSION
	References
7
- Newer Randomized Trials of PFO Closure for Stroke (CLOSE, REDUCE and DEFENSE-PFO)
	INTRODUCTION
	NEWER RANDOMIZED TRIALS OF PFO CLOSURE FOR STROKE
		The CLOSE PFO Trial
		The Gore REDUCE Trial
		The DEFENSE-PFO PFO Trial
	META-ANALYSES OF PFO CLOSURE TRIALS FOR STROKE PREVENTION
	LESSONS LEARNED FROM PFO CLOSURE TRIALS FOR STROKE PREVENTION
	EVOLUTION OF GUIDELINES
	PATIENT SELECTION FOR PFO CLOSURE FOR STROKE
	UNANSWERED QUESTIONS
	References
Part IV: Non-Cerebral Paradoxical Embolism and PFO
8 - Myocardial Infarction and PFO
	INTRODUCTION
		Prevalence of Embolic Myocardial Infarction
		Causes of Embolic Myocardial Infarction
	FREQUENCY OF PARADOXICAL CORONARY EMBOLISM
	EVIDENCE FOR ETIOLOGIC ASSOCIATION OF THE PFO AND EMBOLIC MYOCARDIAL INFARCTIONS
	PREVALENCE OF PFO IN ACUTE CORONARY SYNDROME PATIENTS
	INCIDENCE OF MYOCARDIAL INFARCTION IN PATIENTS WITH A PFO
	RISK OF MYOCARDIAL INFARCTION IN PATIENTS WITH VENOUS THROMBOEMBOLISM
	DIFFERENTIAL DIAGNOSIS
	MANAGEMENT OF PATIENTS WITH MYOCARDIAL INFARCTION ATTRIBUTABLE TO PARADOXICAL CORONARY EMBOLISM
	SECONDARY PREVENTION AFTER PARADOXICAL EMBOLIC MYOCARDIAL INFARCTION IN THE PRESENCE OF A PFO
	CONCLUSIONS
	References
9 - Peripheral Embolism and PFO
	INTRODUCTION
	EPIDEMIOLOGY
	CLINICAL PRESENTATION
	DIAGNOSIS
	MANAGEMENT
	SUMMARY
	References
Part V: Migraine and PFO
10 - Migraine Headache: Clinical Association With PFO and Observational Studies
	INTRODUCTION
	PRIMARY HEADACHES
	SECONDARY HEADACHES
	PATHOPHYSIOLOGY OF MIGRAINE AND MIGRAINE AURA IN PATIENTS WITH RIGHT-TO-LEFT SHUNTS
	CASE-CONTROL STUDIES OF PREVALENCE OF MIGRAINE IN INDIVIDUALS WITH PFO AND PREVALENCE OF PFO IN INDIVIDUALS WITH MIGRAINE
		Prevalence of Migraine in Individuals With PFO and Vice Versa
		Shunt Size in Individuals With PFO and Migraine
	EFFECT OF PFO CLOSURE ON MIGRAINE SEVERITY
	THE LINK BETWEEN MIGRAINE, PFO, AND STROKE
		Stroke in Patients with Migraine
	EFFECT OF ANTITHROMBOTIC THERAPY IN MIGRAINE
	DISCUSSION
	References
11 - Randomized Clinical Trials of PFO Closure for Migraine Headache (MIST, PRIMA, PREMIUM)
	INTRODUCTION
	THE MIST TRIAL
		Why did the MIST Trial Differ from Previous Observational Studies?
	THE PRIMA TRIAL
	THE PREMIUM TRIAL
	SHOULD FUTURE PFO CLOSURE FOR MIGRAINE TRIALS HAVE A SHAM CONTROL ARM?
	META-ANALYSES OF THE TRIALS OF PFO CLOSURE FOR MIGRAINE HEADACHE
	CONCLUSIONS
	References
Part VI: Other Conditions and PFO
12 - Hypoxemia and PFO
	INTRODUCTION
	PFO AND HYPOXEMIC CONDITIONS
		Pathophysiological Interplay Between PFO and Hypoxemia
		PFO and Obstructive Sleep Apnea
		PFO and Chronic Obstructive Pulmonary Disease
		PFO and Pulmonary Hypertension
		Percutaneous PFO Closure for Other Chronic Pulmonary Disorders
		PFO and Platypnea-Orthodeoxia Syndrome
		PFO and Pulmonary Arteriovenous Malformation
		PFO and High-Altitude Pulmonary Edema
		PFO and Exercise Desaturation
		PFO and Left Ventricular Assist Device Implant
	SOCIETY GUIDELINES ON PFO CLOSURE
	SUPPLEMENTARY MATERIALS
	References
13 - Less Recognized Conditions Associated With PFO: Decompression Illness, Carcinoid Heart Disease, Coronary Spasm
	DECOMPRESSION ILLNESS AND PFO
		Decompression Illness
		Pathophysiology of Decompression Illness
		Decompression Illness and PFO
		Factors Associated with Increased Risk of Decompression Illness in the Presence of PFO
		PFO and White Matter Lesions in Divers without Decompression Illness
		Imaging Tests for Detection of PFO
		Candidates for Investigation
		Interventions for PFO-Mediated Decompression Illness
		Summary
	CARCINOID HEART DISEASE AND PFO
		Carcinoid Tumors
		Carcinoid Syndrome and Carcinoid Heart Disease
		PFO in Carcinoid Syndrome and Carcinoid Heart Disease
		PFO and Cyanosis in Patients with Carcinoid Syndrome
		PFO Closure in Patients with Carcinoid Heart Disease
		Summary
	CORONARY SPASM AND PFO
		Coronary Vasospasm
		PFO and Vasoactive Substances
		PFO and Coronary Vasospasm in Carcinoid Syndrome
		PFO and Coronary Vasospasm Status Post Sclerotherapy
		PFO and Coronary Vasospasm without History of Carcinoid or Sclerotherapy
		Summary
	References
Part VII: Safety, Technical Aspects to PFO
Closure, and Future Outlook
14 - Percutaneous PFO Closure: History, Devices, Techniques, Safety, and Informed Consent
	INTRODUCTION
	HISTORY
		The Understanding of PFO-related Pathologies
		Development of Percutaneous Techniques for PFO Closure
		Accumulating Evidence for Clinical Applications
	DEVICES
		Double Disc Devices
			Amplatzer PFO Occluder
			CardioSEAL Device
			STARFlex Device
			Figulla II PFO Occluder
			Gore HELEX Septal Occluder
			Gore Cardioform Septal Occluder
		Nondouble Disc Devices
			FlatStent Occluder
			NobleStitch EL Occluder
			Radiofrequency Fusion
	SAFETY
	INFORMED CONSENT
	CONCLUSION
	References
15 - How I Do It: ICE-Guided Technique for Percutaneous PFO Closure
	INTRODUCTION
	ANATOMIC CONSIDERATIONS
	INSERTING THE INTRACARDIAC ECHOCARDIOGRAPHY CATHETER
	MANIPULATING THE INTRACARDIAC ECHOCARDIOGRAPHY CATHETER
	CLOSING THE PFO
	POST DEPLOYMENT AND INTRACARDIAC ECHOCARDIOGRAPHY CATHETER WITHDRAWAL
	CHALLENGES
	UNUSUAL CASES: TIPS AND TRICKS
	References
16 - How I Do It: Fluoroscopy-Guided Technique for Percutaneous PFO Closure
	INTRODUCTION
	PRELIMINARY EXAMS AND DEVICE SELECTION
	PASSING THE PFO
	INTRODUCING THE DELIVERY SHEATH
	DEVICE DEPLOYMENT
	SECOND OCCLUDER FOR RESIDUAL SHUNT AT FOLLOW-UP[10]
	CONCLUSION
	SUPPLEMENTARY MATERIALS
	Conflicts of interest
	References
17 - PFO Closure: History, Final Thoughts, and Future Outlook
	HISTORY AND LESSONS LEARNED
	FINAL THOUGHTS AND FUTURE OUTLOOK
	References
18 - The Full Spectrum of PFO: Are We Seeing Just the Tip of the Iceberg?
	CLINICAL CASE
	THE FULL SPECTRUM OF PFO [1]
	References
19 - Frequently Asked Questions: PFO Closure With the Amplatzer or Gore Cardioform Devices
	INTRODUCTION
	PERCUTANEOUS CLOSURE OF INTERATRIAL SHUNTS: PFO OR ATRIAL SEPTAL DEFECT
		What Is a PFO?
		What Is a Cryptogenic Stroke?
			Estimate of Incidence of Cryptogenic Stroke Due to PFO
		How Does a PFO Cause a Stroke?
		What Alternative Treatments Are Available?
	RANDOMIZED CONTROLLED CLINICAL TRIALS OF PFO CLOSURE FOR STROKE: THE RESPECT, REDUCE, CLOSE, AND DEFENSE-PFO TRIALS
		An Explanation of the Procedure to Close a PFO With the Amplatzer or Gore Cardioform Device
		PFO Closure for Migraine Headaches
		What Possible Complications Can Occur?
		What Side Effects Can Occur With the PFO Closure Device?
		What Instructions Must I Follow After I Have a PFO Closure Device Placed?
		Could My PFO Have Contributed to My Transient Ischemic Attack?
		Why Was My PFO Not Previously Detected? Is Echocardiography the Only Way to Diagnose This?
		I Had a Transient Ischemic Attack; Are There Any Other Tests You Would Recommend for Me?
		How Soon Should I Have This Procedure?
		What Is the Recovery Like?
		Is There Any Exclusion Criteria to Device Closure?
		Will I Be Able to Feel the Device?
		Can I Travel With the Implanted Device? Will the Device Trigger Airport Security Systems?
		Can I Have a Magnetic Resonance Imaging Study After Having the Device Implanted?
		Can I Have My PFO Closed if I Am Pregnant?
		In Your Expert Opinion, Is There Anything Else I Should Know or Consider Prior to Having My PFO Closed?
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	K
	L
	M
	N
	O
	P
	R
	S
	T
	U
	V
	W
Back Cover