Surgical prophylaxis of recurrent stroke in patients with patent foramen ovale: a pilot study

Details

Serval ID
serval:BIB_B2C67EC30434
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Surgical prophylaxis of recurrent stroke in patients with patent foramen ovale: a pilot study
Journal
Journal of Thoracic and Cardiovascular Surgery
Author(s)
Guffi  M., Bogousslavsky  J., Jeanrenaud  X., Devuyst  G., Sadeghi  H.
ISSN
0022-5223 (Print)
Publication state
Published
Issued date
08/1996
Volume
112
Number
2
Pages
260-3
Notes
Journal Article --- Old month value: Aug
Abstract
Prevention of recurrent stroke in adults with patent foramen ovale represents a therapeutic challenge. Antiplatelet or anticoagulant treatment is widely introduced, but its exact indication is not known. In this pilot study, eight men and three women with previous ischemic cerebral events underwent direct surgical closure of the patent foramen ovale. Mean age was 39.4 (from 30 to 58) years. No coexisting cause of stroke was found after extensive investigations, including blood and coagulation tests, echocardiography, 24-hour three-lead electrocardiographic monitoring, extracranial and transcranial Doppler ultrasonography, and cerebral angiography. Criteria for operation also included at least two of the following: atrial septal aneurysm, multiple cerebral infarcts, a history of multiple cerebral events, and Valsalva strain before stroke. Before operation, one patient had two shunts (1 patent foramen ovale, 1 intrapulmonary shunt). No intraoperative or postoperative complications occurred, but a few hours after operation transient arrhythmias developed in two patients without atrial fibrillation, hemodynamic instability, or embolism. During a median follow-up of 12.2 months, no patient had recurrent stroke. All patients prospectively underwent brain magnetic resonance imaging and contrast echocardiography with simultaneous transcranial Doppler ultrasonography. A residual right-to-left interatrial shunt, smaller than the preoperative one, was observed in only one patient, whereas no lesion was seen on magnetic resonance imaging. Our study suggests that surgical closure of patent foramen ovale in patients with presumed paradoxic embolism is safe, with no recurrent stroke in the first year of follow-up. Further studies are needed to evaluate the long-term prognosis of patients with versus without operation and to define the role of operation as an alternative to prolonged antithrombotic treatment.
Keywords
Adult Anticoagulants/therapeutic use Arrhythmia/etiology Blood Coagulation Tests Brain Ischemia/prevention & control Cerebral Angiography Cerebral Infarction/surgery Cerebrovascular Disorders/*prevention & control Echocardiography Electrocardiography, Ambulatory Embolism/prevention & control Female Follow-Up Studies Heart Aneurysm/surgery Heart Septal Defects, Atrial/*surgery Humans Magnetic Resonance Imaging Male Middle Aged Pilot Projects Platelet Aggregation Inhibitors/therapeutic use Postoperative Complications Prognosis Prospective Studies Recurrence Ultrasonography, Doppler, Transcranial
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 10:01
Last modification date
20/08/2019 15:21
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