Patent Foramen Ovale: The Unresolved Questions

From Top Italian Scientists Journal
Revision as of 13:29, 24 March 2024 by Admin (talk | contribs)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Published
March 5, 2024
Title
Patent Foramen Ovale: The Unresolved Questions
Authors
Imma Forzano, Gaetano Santulli
DOI
10.62684/DMFZ6956
Keywords
Cardiology; Migraine; Patent Foramen Ovale (PFO); Platypnea-orthodeoxia syndrome; Stroke; TIA;
Downloads
Download PDF
Download PDF

Imma Forzano(a), Gaetano Santulli(a,b)

(a) Department of Advanced Biomedical Sciences, Division of Cardiology, “Federico II” University, International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, 80131, Naples, Italy;

(b) Department of Medicine (Division of Cardiology), Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, 10461, NY.

Correspondence to: Department of Medicine (Division of Cardiology), Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, 10461, NY. gsantulli001@gmail.com

Abstract

Patent Foramen Ovale (PFO) is a remnant of fetal circulation that could be observed in the 25% of the population worldwide. PFO is associated to numerous clinical conditions as migraines, coronary embolization, transient ischemic attacks, and stroke. The main PFO concerns are related to its correlation to stroke, in particular in young adults. Despite the impact on morbidity that PFO could have, to date there is not clear evidence about its management and treatment. In this narrative review our aim is to summarize the more recent evidence in the literature dealing with PFO, in order to provide an updated overview on this topic.

Declarations

Conflict of Interest

The Authors declare that there is no conflict of interest.

Funding

The Santulli’s Lab is currently supported in part by the National Institutes of Health (NIH): National Heart, Lung, and Blood Institute (NHLBI: R01-HL164772, R01-HL159062, R01-HL146691, T32-HL144456), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK: R01-DK123259, R01-DK033823), National Center for Advancing Translational Sciences (NCATS: UL1-TR002556-06, UM1-TR004400) to G.S., by the Diabetes Action Research and Education Foundation (to G.S.), by the Waxman Research Foundation (to G.S.), and by the Monique Weill-Caulier and Irma T. Hirschl Trusts (to G.S.).

References

  1. Koutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayiotides T: Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review. Front Neurol 2020, 11:281.
  2. Pristipino C, Sievert H, D'Ascenzo F, Louis Mas J, Meier B, Scacciatella P, Hildick-Smith D, Gaita F, Toni D, Kyrle P et al: European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eur Heart J 2019, 40(38):3182-3195.
  3. Sposato LA, Albin CSW, Elkind MSV, Kamel H, Saver JL: Patent Foramen Ovale Management for Secondary Stroke Prevention: State-of-the-Art Appraisal of Current Evidence. Stroke 2024, 55(1):236-247.
  4. Overell JR, Bone I, Lees KR: Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology 2000, 55(8):1172-1179.
  5. Mojadidi MK, Zaman MO, Elgendy IY, Mahmoud AN, Patel NK, Agarwal N, Tobis JM, Meier B: Cryptogenic Stroke and Patent Foramen Ovale. J Am Coll Cardiol 2018, 71(9):1035-1043.
  6. Meier B, Lock JE: Contemporary management of patent foramen ovale. Circulation 2003, 107(1):5-9.
  7. Ornello R, Degan D, Tiseo C, Di Carmine C, Perciballi L, Pistoia F, Carolei A, Sacco S: Distribution and Temporal Trends From 1993 to 2015 of Ischemic Stroke Subtypes: A Systematic Review and Meta-Analysis. Stroke 2018, 49(4):814-819.
  8. Perera KS, Vanassche T, Bosch J, Giruparajah M, Swaminathan B, Mattina KR, Berkowitz SD, Arauz A, O'Donnell MJ, Ameriso SF et al: Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry. Int J Stroke 2016, 11(5):526-533.
  9. Katsanos AH, Bhole R, Frogoudaki A, Giannopoulos S, Goyal N, Vrettou AR, Ikonomidis I, Paraskevaidis I, Pappas K, Parissis J et al: The value of transesophageal echocardiography for embolic strokes of undetermined source. Neurology 2016, 87(10):988-995.
  10. Larrue V, Berhoune N, Massabuau P, Calviere L, Raposo N, Viguier A, Nasr N: Etiologic investigation of ischemic stroke in young adults. Neurology 2011, 76(23):1983-1988.
  11. Elgendy AY, Saver JL, Amin Z, Boudoulas KD, Carroll JD, Elgendy IY, Grunwald IQ, Gertz ZM, Hijazi ZM, Horlick EM et al: Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale-Associated Stroke. JAMA Neurol 2020, 77(7):878-886.
  12. Chaturvedi A, Moroni F, Axline M, Tomdio A, Mojadidi MK, Gertz Z: Comparative evaluation of intracardiac, transesophageal, and transthoracic echocardiography in the assessment of patent foramen ovale: A retrospective single-center study. Catheter Cardiovasc Interv 2023, 102(7):1348-1356.
  13. Mojadidi MK, Roberts SC, Winoker JS, Romero J, Goodman-Meza D, Gevorgyan R, Tobis JM: Accuracy of transcranial Doppler for the diagnosis of intracardiac right-to-left shunt: a bivariate meta-analysis of prospective studies. JACC Cardiovasc Imaging 2014, 7(3):236-250.
  14. Ahmed MK, Kamal H, Weiss JL, Crumlish A, Shirani P, Sawyer RN, Mowla A: Transesophageal echocardiogram in the evaluation of acute ischemic stroke of young adults. Brain Circ 2021, 7(2):85-91.
  15. de Belder MA, Tourikis L, Griffith M, Leech G, Camm AJ: Transesophageal contrast echocardiography and color flow mapping: methods of choice for the detection of shunts at the atrial level? Am Heart J 1992, 124(6):1545-1550.
  16. Davison P, Clift PF, Steeds RP: The role of echocardiography in diagnosis, monitoring closure and post-procedural assessment of patent foramen ovale. Eur J Echocardiogr 2010, 11(10):i27-34.
  17. Khan R, Karim MN, Hosseini F, Fine N: Diagnostic Accuracy of Transthoracic Echocardiography With Contrast for Detection of Right-to-Left Shunt: A Systematic Review and Meta-analysis. Can J Cardiol 2022, 38(12):1948-1958.
  18. D'Andrea A, Conte M, Riegler L, Scarafile R, Cocchia R, Pezzullo E, Cavallaro M, Di Maio M, Natale F, Santoro G et al: Transcranial Doppler Ultrasound: Incremental Diagnostic Role in Cryptogenic Stroke Part II. J Cardiovasc Echogr 2016, 26(3):71-77.
  19. Serena J, Segura T, Perez-Ayuso MJ, Bassaganyas J, Molins A, Davalos A: The need to quantify right-to-left shunt in acute ischemic stroke: a case-control study. Stroke 1998, 29(7):1322-1328.
  20. Anderson RH, Webb S, Brown NA, Lamers W, Moorman A: Development of the heart: (2) Septation of the atriums and ventricles. Heart 2003, 89(8):949-958.
  21. Evola S, Camarda EA, Triolo OF, Adorno D, D'Agostino A, Novo G, Onorato EM: Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience. J Clin Med 2023, 12(18).
  22. Hara H, Virmani R, Ladich E, Mackey-Bojack S, Titus J, Reisman M, Gray W, Nakamura M, Mooney M, Poulose A et al: Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol 2005, 46(9):1768-1776.
  23. Kutty S, Sengupta PP, Khandheria BK: Patent foramen ovale: the known and the to be known. J Am Coll Cardiol 2012, 59(19):1665-1671.
  24. Pizzino F, Khandheria B, Carerj S, Oreto G, Cusma-Piccione M, Todaro MC, Oreto L, Vizzari G, Di Bella G, Zito C: PFO: Button me up, but wait ... Comprehensive evaluation of the patient. J Cardiol 2016, 67(6):485-492.
  25. Aggeli C, Verveniotis A, Andrikopoulou E, Vavuranakis E, Toutouzas K, Tousoulis D: Echocardiographic features of PFOs and paradoxical embolism: a complicated puzzle. Int J Cardiovasc Imaging 2018, 34(12):1849-1861.
  26. Mirijello A, D'Errico MM, Curci S, Spatuzza P, Graziano D, La Viola M, D'Alessandro V, Grilli M, Vendemiale G, Cassese M et al: Paradoxical embolism with thrombus stuck in a patent foramen ovale: a review of treatment strategies. Eur Rev Med Pharmacol Sci 2018, 22(24):8885-8890.
  27. Windecker S, Stortecky S, Meier B: Paradoxical embolism. J Am Coll Cardiol 2014, 64(4):403-415.
  28. Thaler DE, Ruthazer R, Weimar C, Mas JL, Serena J, Di Angelantonio E, Papetti F, Homma S, Mattle HP, Nedeltchev K et al: Recurrent stroke predictors differ in medically treated patients with pathogenic vs. other PFOs. Neurology 2014, 83(3):221-226.
  29. Kent DM, Ruthazer R, Weimar C, Mas JL, Serena J, Homma S, Di Angelantonio E, Di Tullio MR, Lutz JS, Elkind MS et al: An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology 2013, 81(7):619-625.
  30. Schneider B, Hanrath P, Vogel P, Meinertz T: Improved morphologic characterization of atrial septal aneurysm by transesophageal echocardiography: relation to cerebrovascular events. J Am Coll Cardiol 1990, 16(4):1000-1009.
  31. Schuchlenz HW, Saurer G, Weihs W, Rehak P: Persisting eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events. J Am Soc Echocardiogr 2004, 17(3):231-233.
  32. Taramasso M, Nietlispach F, Maisano F, Meier B: Patent foramen ovale: indications for closure and techniques. EuroIntervention 2016, 12 Suppl X:X7-X12.
  33. Lamy C, Giannesini C, Zuber M, Arquizan C, Meder JF, Trystram D, Coste J, Mas JL: Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke 2002, 33(3):706-711.
  34. Ioannidis SG, Mitsias PD: Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding? Front Neurol 2020, 11:567.
  35. Agrawal A, Palkar A, Talwar A: The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review. Respir Med 2017, 129:31-38.
  36. Mirwais S, Mirwais M, Altaf A, Collins J: Patent Foramen Ovale With Platypnea - Orthodeoxia Syndrome: A Case Report. Cureus 2020, 12(10):e10958.
  37. Rigatelli G: Migraine and patent foramen ovale: connecting flight or one-way ticket? Expert Rev Neurother 2008, 8(9):1331-1337.
  38. Signoriello E, Cirillo M, Puoti G, Signoriello G, Negro A, Koci E, Melone MAB, Rapacciuolo A, Maresca G, Lus G: Migraine as possible red flag of PFO presence in suspected demyelinating disease. J Neurol Sci 2018, 390:222-226.
  39. Mahmoud AN, Mentias A, Elgendy AY, Qazi A, Barakat AF, Saad M, Mohsen A, Abuzaid A, Mansoor H, Mojadidi MK et al: Migraine and the risk of cardiovascular and cerebrovascular events: a meta-analysis of 16 cohort studies including 1 152 407 subjects. BMJ Open 2018, 8(3):e020498.
  40. Khessali H, Mojadidi MK, Gevorgyan R, Levinson R, Tobis J: The effect of patent foramen ovale closure on visual aura without headache or typical aura with migraine headache. JACC Cardiovasc Interv 2012, 5(6):682-687.
  41. Papa M, Gaspardone A, Fragasso G, Ajello S, Gioffre G, Iamele M, Iani C, Margonato A: Usefulness of transcatheter patent foramen ovale closure in migraineurs with moderate to large right-to-left shunt and instrumental evidence of cerebrovascular damage. Am J Cardiol 2009, 104(3):434-439.
  42. Wahl A, Praz F, Tai T, Findling O, Walpoth N, Nedeltchev K, Schwerzmann M, Windecker S, Mattle HP, Meier B: Improvement of migraine headaches after percutaneous closure of patent foramen ovale for secondary prevention of paradoxical embolism. Heart 2010, 96(12):967-973.
  43. Trabattoni D, Brambilla M, Canzano P, Becchetti A, Teruzzi G, Porro B, Fiorelli S, Muratori M, Tedesco CC, Veglia F et al: Migraine in Patients Undergoing PFO Closure: Characterization of a Platelet-Associated Pathophysiological Mechanism: The LEARNER Study. JACC Basic Transl Sci 2022, 7(6):525-540.
  44. Sommer RJ, Nazif T, Privitera L, Robbins BT: Retrospective review of thienopyridine therapy in migraineurs with patent foramen ovale. Neurology 2018, 91(22):1002-1009.
  45. Devos P, Guedeney P, Montalescot G, Group AS: Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges. J Clin Med 2023, 13(1).
  46. Schwerzmann M, Seiler C, Lipp E, Guzman R, Lovblad KO, Kraus M, Kucher N: Relation between directly detected patent foramen ovale and ischemic brain lesions in sport divers. Ann Intern Med 2001, 134(1):21-24.
  47. Honek J, Sramek M, Sefc L, Januska J, Fiedler J, Horvath M, Tomek A, Novotny S, Honek T, Veselka J: High-grade patent foramen ovale is a risk factor of unprovoked decompression sickness in recreational divers. J Cardiol 2019, 74(6):519-523.
  48. Honek J, Sramek M, Honek T, Tomek A, Sefc L, Januska J, Fiedler J, Horvath M, Novotny S, Brabec M et al: Screening and Risk Stratification Strategy Reduced Decompression Sickness Occurrence in Divers With Patent Foramen Ovale. JACC Cardiovasc Imaging 2022, 15(2):181-189.
  49. Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, Derumeaux G, Furlan AJ, Herrmann HC, Juni P et al: Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke. JAMA 2021, 326(22):2277-2286.
  50. Kasner SE, Lattanzi S, Fonseca AC, Elgendy AY: Uncertainties and Controversies in the Management of Ischemic Stroke and Transient Ischemic Attack Patients With Patent Foramen Ovale. Stroke 2021, 52(12):e806-e819.
  51. Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O'Donnell MJ, Sacco RL, Connolly SJ, Cryptogenic Stroke EIWG: Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014, 13(4):429-438.
  52. Horlick E, Kavinsky CJ, Amin Z, Boudoulas KD, Carroll JD, Hijazi ZM, Leifer D, Lutsep HL, Rhodes JF, Tobis JM: SCAI expert consensus statement on operator and institutional requirements for PFO closure for secondary prevention of paradoxical embolic stroke: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Catheter Cardiovasc Interv 2019, 93(5):859-874.
  53. Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, Felberg R, Herrmann H, Kar S, Landzberg M et al: Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 2012, 366(11):991-999.
  54. Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, Andersen G, Ibrahim R, Schuler G, Walton AS et al: Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 2013, 368(12):1083-1091.
  55. Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Bejot Y, Vuillier F, Detante O et al: Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. N Engl J Med 2017, 377(11):1011-1021.
  56. Lee PH, Song JK, Kim JS, Heo R, Lee S, Kim DH, Song JM, Kang DH, Kwon SU, Kang DW et al: Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial. J Am Coll Cardiol 2018, 71(20):2335-2342.
  57. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, Tirschwell DL, Investigators R: Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med 2017, 377(11):1022-1032.
  58. Sondergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, Settergren M, Sjostrand C, Roine RO, Hildick-Smith D et al: Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med 2017, 377(11):1033-1042.
  59. Healey JS, Alings M, Ha A, Leong-Sit P, Birnie DH, de Graaf JJ, Freericks M, Verma A, Wang J, Leong D et al: Subclinical Atrial Fibrillation in Older Patients. Circulation 2017, 136(14):1276-1283.
  60. Rouesnel P, Babuty D, Fauchier L, Saudeau D, Hurreesing R, Cosnay P, Garnier LF: Comparative study of atrial vulnerability in patients with unexplained ischemic stroke or lone atrial paroxysmal fibrillation. Ann Cardiol Angeiol (Paris) 2003, 52(4):220-225.
  61. Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Elegamandji B, Alamowitch S, Crozier S, Sabben C, Deltour S et al: Supraventricular Arrhythmia Following Patent Foramen Ovale Percutaneous Closure. JACC Cardiovasc Interv 2022, 15(22):2315-2322.
  62. Kramer P, Opgen-Rhein B, Berger F, Nordmeyer J: Left atrial disc device thrombosis after atrial defect closure with the Gore(R) Cardioform septal occluder: A case series. Catheter Cardiovasc Interv 2023, 102(2):359-363.
  63. Pristipino C, Sievert H, D'Ascenzo F, Mas JL, Meier B, Scacciatella P, Hildick-Smith D, Gaita F, Toni D, Kyrle P et al: European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. EuroIntervention 2019, 14(13):1389-1402.
  64. Ruiz CE, Kipshidze N, Chiam PT, Gogorishvili I: Feasibility of patent foramen ovale closure with no-device left behind: first-in-man percutaneous suture closure. Catheter Cardiovasc Interv 2008, 71(7):921-926.
  65. Gaspardone A, De Marco F, Sgueglia GA, De Santis A, Iamele M, D'Ascoli E, Tusa M, Corciu A, Mullen M, Nobles A et al: Novel percutaneous suture-mediated patent foramen ovale closure technique: early results of the NobleStitch EL Italian Registry. EuroIntervention 2018, 14(3):e272-e279.
  66. Onorato EM, Grancini L, Monizzi G, Mastrangelo A, Fabbiocchi F, Bartorelli AL: Noblestitch(R) system for PFO closure: A novel but judicious alternative to traditional devices-A case report. Front Cardiovasc Med 2023, 10:1095661.