Patent foramen ovale surgery: Difference between revisions
/* ACC / AHA Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT){{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the mana |
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==Indications for Closure of a Patent Foramen Ovale== | ==Indications for Closure of a Patent Foramen Ovale== | ||
== | ==American Academy of Neurology Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref>== | ||
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Practice Recommendations | '''Practice Recommendations''' | ||
'''1)'''For patients who have had a cryptogenic stroke and have a patent foramen ovale (PFO), the evidence indicates that the risk of subsequent stroke or death is no different from other cryptogenic stroke patients without PFO when treated medically with antiplatelet agents or | '''1)'''For patients who have had a [[Paradoxical embolism|cryptogenic stroke]] and have a [[patent foramen ovale]] ([[PFO]]), the evidence indicates that the risk of subsequent [[stroke]] or death is no different from other [[Paradoxical embolism|cryptogenic stroke]] patients without [[PFO]] when treated medically with [[antiplatelet]] agents or [[anticoagulant]]s. Therefore, in persons with a [[Paradoxical embolism|cryptogenic stroke]] receiving such therapy, neurologists should communicate to patients and their families that presence of PFO does not confer an increased risk for subsequent [[stroke]] compared to other [[Paradoxical embolism|cryptogenic stroke]] patients without atrial abnormalities (Level A). However, it is possible that the combination of [[PFO]] and atrial septal aneurysm (ASA) confers an increased risk of subsequent [[stroke]] in medically treated patients who are less than 55 years of age. Therefore, in younger [[stroke]] patients, studies that can identify [[PFO]] or atrial septal aneurysm (ASA) may be considered for prognostic purposes '''(Level C)'''. | ||
'''2)'''Among patients with a cryptogenic stroke and atrial septal abnormalities, there is insufficient evidence to determine the superiority of aspirin or warfarin for prevention of recurrent stroke or death (Level U), but the risks of minor bleeding are possibly greater with warfarin (Level C). There is insufficient evidence regarding the effectiveness of either surgical or percutaneous closure of PFO (Level U). | '''2)'''Among patients with a [[Paradoxical embolism|cryptogenic stroke]] and atrial septal abnormalities, there is insufficient evidence to determine the superiority of [[aspirin]] or [[warfarin]] for prevention of recurrent [[stroke]] or death (Level U), but the risks of minor [[bleeding]] are possibly greater with [[warfarin]] (Level C). There is insufficient evidence regarding the effectiveness of either surgical or percutaneous closure of [[PFO]] (Level U). | ||
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Revision as of 21:27, 5 September 2011
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Patent Foramen Ovale Microchapters |
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Patent foramen ovale surgery On the Web |
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American Roentgen Ray Society Images of Patent foramen ovale surgery |
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Risk calculators and risk factors for Patent foramen ovale surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]
Overview
Indications for Closure of a Patent Foramen Ovale
American Academy of Neurology Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT)[1]
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Practice Recommendations 1)For patients who have had a cryptogenic stroke and have a patent foramen ovale (PFO), the evidence indicates that the risk of subsequent stroke or death is no different from other cryptogenic stroke patients without PFO when treated medically with antiplatelet agents or anticoagulants. Therefore, in persons with a cryptogenic stroke receiving such therapy, neurologists should communicate to patients and their families that presence of PFO does not confer an increased risk for subsequent stroke compared to other cryptogenic stroke patients without atrial abnormalities (Level A). However, it is possible that the combination of PFO and atrial septal aneurysm (ASA) confers an increased risk of subsequent stroke in medically treated patients who are less than 55 years of age. Therefore, in younger stroke patients, studies that can identify PFO or atrial septal aneurysm (ASA) may be considered for prognostic purposes (Level C). 2)Among patients with a cryptogenic stroke and atrial septal abnormalities, there is insufficient evidence to determine the superiority of aspirin or warfarin for prevention of recurrent stroke or death (Level U), but the risks of minor bleeding are possibly greater with warfarin (Level C). There is insufficient evidence regarding the effectiveness of either surgical or percutaneous closure of PFO (Level U).
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Technique
The Ampltazer septal occluder (ASO) is the most commonly used device as it allows closure of large cavities, is easy to implant, and boasts high success rates. As an instrument, the ASO consists of two self-expandable round discs connected to each other with a 4-mm waist, made up of 0.004–0.005´´ nitinol wire mesh filled with Dacron fabric. Implantation of the device is relatively easy. The prevalence of residual defect is low. The disadvantages are a thick profile of the device and concern related to a large amount of nitinol (a nickel-titanium compound) in the device and consequent potential for nickel toxicity.
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References
- ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.