Is Moderate/Large Residual Shunt After PFO Closure Justifiable for a Patient with a Prior History of Cryptogenic Stroke and Transient Ischemic Attack?

IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Francesco Melillo, Gregory Popusoi, Francesca Frecentese, Vittoria Miano, Alessandro Santoro, Tullio Tesorio, Eustaquio Maria Onorato
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Abstract

A 36-year-old woman suffered from an embolic stroke of an undetermined source documented by magnetic resonance imaging with residual right arm weakness. She underwent percutaneous patent foramen ovale (PFO) closure with an 18/25 mm device in another center. One year later, the patient suffered from a transient ischemic attack with dysarthria. She asked for a second opinion at our institution and a contrast-transthoracic (cTTE) /transesophageal echocardiography showed a large residual right-to-left shunt (RLS) through a still patent tunnel after PFO closure. Written informed consent for a redo procedure was obtained from the patient. A catheter-based closure of the residual shunt was therefore planned under local anesthesia and rotational intracardiac echo monitoring. A second equally sized disc (18/18 mm) device was successfully implanted without complications. The patient was discharged home the following day in good clinical condition. Dual antiplatelet therapy was recommended for the first 2 months and then single antiplatelet therapy up to 6 months. At the 6-month follow-up, the cTTE color Doppler showed the stable position of the two nitinol double-disc devices and the c-transcranial Doppler confirmed the abolition of the residual RLS.

对于既往有隐源性脑卒中和短暂性脑缺血发作病史的患者,PFO 关闭后的中度/大残留分流是否合理?
一名 36 岁的女性因不明原因的栓塞性中风,经磁共振成像检查发现右臂残余无力。她在另一家医院接受了经皮卵圆孔(PFO)闭合术,使用的是 18/25 毫米装置。一年后,患者突发短暂性脑缺血并伴有构音障碍。造影剂经胸(cTTE)/经食道超声心动图显示,PFO 关闭术后仍有一个通畅的通道,残留大量右向左分流(RLS)。患者在知情同意的情况下接受了重做手术。因此,计划在局部麻醉和旋转式心内回声监测下,用导管关闭残留的分流。第二个同样大小的圆盘(18/18 毫米)装置被成功植入,没有出现并发症。患者第二天出院回家,临床状况良好。建议在最初的 2 个月内使用双联抗血小板疗法,然后在 6 个月内使用单联抗血小板疗法。6 个月随访时,cTTE 彩色多普勒显示两个镍钛诺双盘装置位置稳定,c-经颅多普勒证实残余 RLS 消失。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International heart journal
International heart journal 医学-心血管系统
CiteScore
2.50
自引率
6.70%
发文量
148
审稿时长
6-12 weeks
期刊介绍: Authors of research articles should disclose at the time of submission any financial arrangement they may have with a company whose product figures prominently in the submitted manuscript or with a company making a competing product. Such information will be held in confidence while the paper is under review and will not influence the editorial decision, but if the article is accepted for publication, the editors will usually discuss with the authors the manner in which such information is to be communicated to the reader.
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