BACKGROUND: It has been suggested that prominent Eustachian valve (EV) and Chiari's network (CN) predispose to paradoxical embolism but their presence in patients with presumed paradoxical stroke is not always easily detectable by transesophageal echocardiography (TEE). We sought to prospectively assess the frequency of EV/CN as assessed by intracardiac echocardiography (ICE) in patients submitted to patent foramen ovale (PFO) transcatheter closure in order to investigate their role in determining shunt severity and risk of multiple paradoxical embolisms. METHODS: Over a 36-month period, we prospectively enrolled 98 consecutive patients (mean age 37 +/- 12.5 years, 68 females) with previous stroke referred to our center for PFO catheter-based closure. All patients underwent transcranial Doppler ultrasound (TC-D), TEE and ICE-guided transcatheter closure. RESULTS: After ICE study and measurements, a prominent EV or CN were diagnosed on ICE in 72 patients (73.4%), whereas in 45 (45.9%, P < 0.01) on TEE. Patients with EV/CN had more frequently a curtain pattern on TC-D, a larger right-to-left shunt, and recurrent cerebral paradoxical embolisms before closure. EV/CN and medium-large shunt on TEE were the strongest predictors of recurrent paradoxical embolisms. CONCLUSIONS: This study suggests that EV and CN have a deep impact on the pathophysiology of paradoxical embolism: EV and CN should be considered as adjunctive risk factors for paradoxical embolism in the decision-making process involving PFO patients. Copyright 2008 Wiley-Liss, Inc.
BACKGROUND: It has been suggested that prominent Eustachian valve (EV) and Chiari's network (CN) predispose to paradoxical embolism but their presence in patients with presumed paradoxical stroke is not always easily detectable by transesophageal echocardiography (TEE). We sought to prospectively assess the frequency of EV/CN as assessed by intracardiac echocardiography (ICE) in patients submitted to patent foramen ovale (PFO) transcatheter closure in order to investigate their role in determining shunt severity and risk of multiple paradoxical embolisms. METHODS: Over a 36-month period, we prospectively enrolled 98 consecutive patients (mean age 37 +/- 12.5 years, 68 females) with previous stroke referred to our center for PFO catheter-based closure. All patients underwent transcranial Doppler ultrasound (TC-D), TEE and ICE-guided transcatheter closure. RESULTS: After ICE study and measurements, a prominent EV or CN were diagnosed on ICE in 72 patients (73.4%), whereas in 45 (45.9%, P < 0.01) on TEE. Patients with EV/CN had more frequently a curtain pattern on TC-D, a larger right-to-left shunt, and recurrent cerebral paradoxical embolisms before closure. EV/CN and medium-large shunt on TEE were the strongest predictors of recurrent paradoxical embolisms. CONCLUSIONS: This study suggests that EV and CN have a deep impact on the pathophysiology of paradoxical embolism: EV and CN should be considered as adjunctive risk factors for paradoxical embolism in the decision-making process involving PFO patients. Copyright 2008 Wiley-Liss, Inc.
Authors: Shiva P Ponamgi; Vaibhav R Vaidya; Christopher V Desimone; Amit Noheria; David O Hodge; Joshua P Slusser; Naser M Ammash; Charles J Bruce; Alejandro A Rabinstein; Paul A Friedman; Samuel J Asirvatham Journal: Pacing Clin Electrophysiol Date: 2017-02-07 Impact factor: 1.976
Authors: Carlos V Serrano; Alexandre de M Soeiro; Tatiana C A Torres Leal; Lucas C Godoy; Bruno Biselli; Luiz Akira Hata; Eduardo B Martins; Isabela C K Abud-Manta; Caio A M Tavares; Francisco Akira Malta Cardozo; Múcio Tavares de Oliveira Journal: Arq Bras Cardiol Date: 2019-08-08 Impact factor: 2.000
Authors: Gary Tse; William K K Wu; Jenny Chi Ling Lai; Mengqi Gong; George Bazoukis; Wing Tak Wong; Sunny Hei Wong; Konstantinos Lampropoulos; Adrian Baranchuk; Lap Ah Tse; Yunlong Xia; Guangping Li; Martin C S Wong; Yat Sun Chan; Nan Mu; Mei Dong; Tong Liu Journal: F1000Res Date: 2017-12-27