PFO and Paradoxical Embolism Producing Events Other Than Stroke
PFO and Paradoxical Embolism Producing Events Other Than Stroke
复制标题
DOI：
10.1002/ccd.22884
复制
发表时间：
2011-05-01
影响因子：
2.3
通讯作者：
Tobis, Jonathan M.
中科院分区：
文献类型：
--
作者：
Dao, Catherine N.;Tobis, Jonathan M.
背景资料：卵圆孔未闭（PFO）是脑事件（如隐源性卒中、短暂性脑缺血发作和偏头痛）的危险因素。PFO与非脑性、反常的全身性栓塞事件（如心肌梗死（MI）、肾梗死和肢体缺血）相关的情况要少得多。这份报告详细介绍了在我们的机构系统性反常栓塞的发病率。方法：对2001年至2009年416例PFO患者的相关情况进行评估。对患者的临床病史和病历进行回顾，以了解隐源性卒中、短暂性脑缺血发作（TIA）、偏头痛、动脉去饱和和非脑系统性栓塞的发生率。结果如下：作为主要表现症状，219例患者诊断为隐源性卒中，38例患者有偏头痛，80例患者有短暂性神经功能缺损，与TIA或复杂头痛一致。12例患者（占总人群的2.9%）被推定诊断为全身性栓塞。这些患者中有8例通过心脏生物标志物升高、心电图改变和/或左心室壁运动异常的影像学证据诊断为急性MI，血管造影显示无阻塞性冠状动脉疾病证据。4例患者有体动脉外周栓塞的证据，包括腘动脉、眼动脉和肱动脉。197例患者（占总人群的47.4%）进行了PFO闭合，包括全身栓塞组的8例患者。所有闭合手术均成功。结论：尽管大多数反常栓塞进入大脑，但非大脑反常栓塞也与PFO有关。除了血栓栓塞外，还可能存在血管活性物质的反常通道，从而引起严重的冠状动脉痉挛和心肌梗死。诊断往往是具有挑战性的，因为缺乏明确的标准和需要排除其他潜在的病因。(C)2011 Wiley-Liss，Inc.
Background: A patent foramen ovale (PFO) is a risk factor for cerebral events such as cryptogenic stroke, transient ischemic attacks, and migraine headaches. Far less commonly, PFO is associated with non-cerebral, paradoxical systemic embolic events such as myocardial infarction (MI), renal infarct, and limb ischemia. This report details the incidence of systemic paradoxical emboli at our institution. Methods: 416 patients were referred for evaluation of PFO related conditions from 2001 to 2009. Clinical history and medical records of the patients were reviewed for incidence of cryptogenic stroke, transient ischemic attack (TIA), migraine headache, arterial desaturation, and noncerebral systemic embolism. Results: As the primary presenting symptom, 219 patients had a diagnosis of cryptogenic stroke, 38 patients had migraine headaches, and 80 patients had transient neurologic deficits consistent with a TIA or complex headache. Twelve patients (2.9% of the total population) presented with a presumptive diagnosis of systemic embolism. Eight of these patients had acute MI diagnosed by elevated cardiac biomarkers, electrocardiogram changes, and/or imaging evidence of a left ventricular wall motion abnormality, without evidence of obstructive coronary disease on angiography. Four patients had evidence of peripheral embolism to a systemic artery, including the popliteal artery, ophthalmic artery, and brachial artery. PFO closure was performed in 197 patients (47.4% of the total population), including eight patients in the systemic embolism group. All closure procedures were successful. Conclusion: Although most paradoxical emboli travel to the brain, noncerebral paradoxical embolism is also associated with PFO. In addition to embolism of thrombus, there may be paradoxical passage of vasoactive chemicals that induce intense coronary spasm and myocardial infarction. Diagnosis is often challenging, given the lack of definitive criteria and the need to exclude other potential etiologies. (C) 2011 Wiley-Liss, Inc.