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Case Report| Volume 27, ISSUE 3, P113-115, March 2023

Patent foramen Ovale-related paradoxical embolism after noncardiac surgery

Published:November 29, 2022DOI:https://doi.org/10.1016/j.jccase.2022.11.001
Patent foramen Ovale-related paradoxical embolism after noncardiac surgery
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      Abstract

      Patent foramen ovale (PFO) is a remnant of the fetal circulation that remains in a significant portion of the adult population, predisposing to a higher risk of stroke. This risk is further elevated in the postoperative hypercoagulative period. Here we present a case where a patient underwent a total knee arthroplasty and presented with right-sided hemiparesis on post-operative day 2. Subsequently, the patient underwent percutaneous PFO closure with a 25-mm Amplatzer PFO Occluder (Abbott; Chicago, IL, USA). The patient has not had a stroke since the PFO closure. Recent randomized trials have demonstrated superiority of percutaneous PFO closure over standard-of-care medical therapy for secondary prevention of PFO-associated stroke. Since post-operative PFO-associated stroke is under-recognized in clinical practice, further large-cohort studies are needed to evaluate whether PFO screening and device closure would decrease post-operative stroke risk for noncardiac surgeries.

      Learning Objective

      Patent foramen ovale (PFO) is a remnant of the fetal circulation commonly found in the adult population, which can increase the risk of stroke. Stroke is a complication of PFO, yet closure of this remnant only occurs on a specific case-by-case basis. Further research in this area is required to determine whether a larger population would benefit from PFO closure.

      Keywords

      Abbreviations:

      PFO (Patent Foramen Ovale), CHD (Congenital Heart Defect), CI (Confidence Interval), NIHSS (US National Institutes of Health Stroke Scale), RA (Right atrium), RV (Right ventricle), LA (Left atrium), LV (Left ventricle)
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      References

        • Meissner I.
        • Khandheria B.K.
        • Heit J.A.
        • Petty G.W.
        • Sheps S.G.
        • Schwartz G.L.
        • Whisnant J.P.
        • Wiebers D.O.
        • Covalt J.L.
        • Petterson T.M.
        • Christianson T.J.
        • Agmon Y.
        Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study.
        J Am Coll Cardiol. 2006; 47 (Epub 2005 Dec 6 PMID: 16412874): 440-445https://doi.org/10.1016/j.jacc.2005.10.044
        View in Article
        • Vaduganathan M.
        • Qamar A.
        • Gupta A.
        • Bajaj N.
        • Golwala H.B.
        • Pandey A.
        • Bhatt D.L.
        Patent foramen ovale closure for secondary prevention of cryptogenic stroke: Updated meta-analysis of randomized clinical trials.
        Am J Med. 2018; 131 (Epub 2017 Dec 8. PMID: 29229471; PMCID: PMC5910216): 575-577https://doi.org/10.1016/j.amjmed.2017.11.027
        View in Article
        • Mojadidi M.K.
        • Elgendy A.Y.
        • Elgendy I.Y.
        • Mahmoud A.N.
        • Elbadawi A.
        • Eshtehardi P.
        • Patel N.K.
        • Wayangankar S.
        • Tobis J.M.
        • Meier B.
        Transcatheter patent foramen ovale closure after cryptogenic stroke: an updated meta-analysis of randomized trials.
        JACC Cardiovasc Interv. 2017; 10: 2228-2230https://doi.org/10.1016/j.jcin.2017.09.002
        View in Article
        • Villablanca P.A.
        • Lemor A.
        • So C.Y.
        • Kang G.
        • Jain T.
        • Gupta T.
        • Ando T.
        • Mohananey D.
        • Ranka S.
        • Hernandez-Suarez D.F.
        • Michel P.
        • Frisoli T.
        • Wang D.D.
        • Eng M.
        • O'Neill W.
        • et al.
        Increased risk of perioperative ischemic stroke in patients who undergo noncardiac surgery with preexisting atrial septal defect or patent foramen ovale.
        J Cardiothorac Vasc Anesth. 2020; 34 (Epub 2020 Jan 16 PMID: 32127264): 2060-2068https://doi.org/10.1053/j.jvca.2020.01.016
        View in Article
        • Mojadidi M.K.
        • Zaman M.O.
        • Elgendy I.Y.
        • Mahmoud A.N.
        • Patel N.K.
        • Agarwal N.
        • Tobis J.M.
        • Meier B.
        Cryptogenic stroke and patent foramen ovale.
        J Am Coll Cardiol. 2018; 71 (PMID: 29495983): 1035-1043https://doi.org/10.1016/j.jacc.2017.12.059
        View in Article
        • Hobbes B.
        • Akseer S.
        • Pikula A.
        • Huszti E.
        • Devereaux P.J.
        • Horlick E.
        • Abrahamyan L.
        Risk of perioperative stroke in patients with patent foramen ovale: a systematic review and meta-analysis.
        Can J Cardiol. 2022; 38 (PMID: 35247468): 1189-1200https://doi.org/10.1016/j.cjca.2022.02.026
        View in Article
        • Ng P.Y.
        • Ng A.K.
        • Subramaniam B.
        • Burns S.M.
        • Herisson F.
        • Timm F.P.
        • Med C.
        • Rudolph M.I.
        • Med C.
        • Scheffenbichler F.
        • Med C.
        • Friedrich S.
        • Med C.
        • Houle T.T.
        • Bhatt D.L.
        • et al.
        Association of preoperatively diagnosed patent foramen ovale with perioperative ischemic stroke.
        JAMA. 2018; 319 (PMID: 29411032; PMCID: PMC5839297): 452-462https://doi.org/10.1001/jama.2017.21899
        View in Article
        • Kasner S.E.
        • Messe S.R.
        Is patent foramen ovale a risk factor for perioperative stroke?.
        JAMA. 2018; 319 (PMID: 29411017): 446-447https://doi.org/10.1001/jama.2017.21902
        View in Article
        • Mas J.L.
        • Derumeaux G.
        • Guillon B.
        • Massardier E.
        • Hosseini H.
        • Mechtouff L.
        • Arquizan C.
        • Béjot Y.
        • Vuillier F.
        • Detante O.
        • Guidoux C.
        • Canaple S.
        • Vaduva C.
        • Dequatre-Ponchelle N.
        • Sibon I.
        • et al.
        Patent foramen ovale closure or anticoagulation vs. Antiplatelets after stroke.
        N Engl J Med. 2017; 377 (PMID: 28902593): 1011-1021https://doi.org/10.1056/NEJMoa1705915
        View in Article
        • Lee P.H.
        • Song J.K.
        • Kim J.S.
        • Heo R.
        • Lee S.
        • Kim D.H.
        • Song J.M.
        • Kang D.H.
        • Kwon S.U.
        • Kang D.W.
        • Lee D.
        • Kwon H.S.
        • Yun S.C.
        • Sun B.J.
        • Park J.H.
        • et al.
        Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO trial.
        J Am Coll Cardiol. 2018; 71 (Epub 2018 Mar 12 PMID: 29544871): 2335-2342https://doi.org/10.1016/j.jacc.2018.02.046
        View in Article

      Article info

      Publication history

      Published online: November 29, 2022
      Accepted: November 7, 2022
      Received in revised form: October 27, 2022
      Received: August 4, 2022

      Identification

      DOI: https://doi.org/10.1016/j.jccase.2022.11.001

      Copyright

      © 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.

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