Patent foramen ovale surgery: Difference between revisions
(/* American Academy of Neurology Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT){{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 gui) |
(/* American Academy of Neurology Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT){{cite journal| author=Messé SR, Silverman IE, Kizer JR, Homma S, Zahn C, Gronseth G et al.| title=Practice parameter: rec) |
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'''U''' = Data inadequate or conflicting. Given current knowledge, treatment (test, predictor) is unproven. | '''U''' = Data inadequate or conflicting. Given current knowledge, treatment (test, predictor) is unproven. | ||
==American Academy of Chest Physicians Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT) <ref name="pmid15383482">{{cite journal| author=Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P| title=Antithrombotic and thrombolytic therapy for ischemic stroke: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. | journal=Chest | year= 2004 | volume= 126 | issue= 3 Suppl | pages= 483S-512S | pmid=15383482 | doi=10.1378/chest.126.3_suppl.483S | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15383482 }} </ref> | |||
'''Findings''' | |||
No clear advantage of [[warfarin]] over [[antiplatelet]]s | |||
'''Recommendations''' | |||
[[Antiplatelet]] treatment recommended | |||
==Technique== | ==Technique== | ||
Revision as of 22:06, 5 September 2011
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Patent Foramen Ovale Microchapters |
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Patent foramen ovale surgery On the Web |
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Risk calculators and risk factors for Patent foramen ovale surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]
Overview
Indications for Closure of a Patent Foramen Ovale
American Academy of Neurology Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT)[1]
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Practice Recommendations 1) For patients who have had a cryptogenic stroke and have a patent foramen ovale (PFO), the evidence indicates that the risk of subsequent stroke or death is no different from other cryptogenic stroke patients without PFO when treated medically with antiplatelet agents or anticoagulants. Therefore, in persons with a cryptogenic stroke receiving such therapy, neurologists should communicate to patients and their families that presence of PFO does not confer an increased risk for subsequent stroke compared to other cryptogenic stroke patients without atrial abnormalities (Level A). However, it is possible that the combination of PFO and atrial septal aneurysm (ASA) confers an increased risk of subsequent stroke in medically treated patients who are less than 55 years of age. Therefore, in younger stroke patients, studies that can identify PFO or atrial septal aneurysm (ASA) may be considered for prognostic purposes (Level C). 2) Among patients with a cryptogenic stroke and atrial septal abnormalities, there is insufficient evidence to determine the superiority of aspirin or warfarin for prevention of recurrent stroke or death (Level U), but the risks of minor bleeding are possibly greater with warfarin (Level C). There is insufficient evidence regarding the effectiveness of either surgical or percutaneous closure of PFO (Level U). |
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Rating of Recommendations
A = Established as effective, ineffective, or harmful for the given condition in the specified population.
B = Probably effective, ineffective, or harmful for the given condition in the specified population.
C = Possibly effective, ineffective, or harmful for the given condition in the specified population.
U = Data inadequate or conflicting. Given current knowledge, treatment (test, predictor) is unproven.
==American Academy of Chest Physicians Guidelines for prevention of recurrent cerebral embolism in patent foramen ovale (DO NOT EDIT) [2]
Findings No clear advantage of warfarin over antiplatelets
Recommendations Antiplatelet treatment recommended
Technique
The Ampltazer septal occluder (ASO) is the most commonly used device as it allows closure of large cavities, is easy to implant, and boasts high success rates. As an instrument, the ASO consists of two self-expandable round discs connected to each other with a 4-mm waist, made up of 0.004–0.005´´ nitinol wire mesh filled with Dacron fabric. Implantation of the device is relatively easy. The prevalence of residual defect is low. The disadvantages are a thick profile of the device and concern related to a large amount of nitinol (a nickel-titanium compound) in the device and consequent potential for nickel toxicity.
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References
- ↑ Messé SR, Silverman IE, Kizer JR, Homma S, Zahn C, Gronseth G; et al. (2004). "Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 62 (7): 1042–50. PMID 15078999.
- ↑ Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P (2004). "Antithrombotic and thrombolytic therapy for ischemic stroke: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest. 126 (3 Suppl): 483S–512S. doi:10.1378/chest.126.3_suppl.483S. PMID 15383482.