González-Patiño MA, Amador-Mena JE, Rodríguez-Weber FL

Language: Spanish
References: 16
Page: 512-519
PDF size: 390.98 Kb.

ABSTRACT

Background: Up to 40% of ischemic strokes are of cryptogenic origin; these cases have been associated with a patent foramen ovale (PFO, a right to left shunt). This defect is likely to be closed in young patients with or without predisposing comorbidities; the decision as to whether the presence of a PFO should require medical or surgical management has not yet been established.
Objective: To question the application of the treatment reported by multicenter studies that affirm that a patent foramen ovale requires surgical treatment vs diary clinical practice.
Material and method: An observational, descriptive and retrospective study was conducted from March 2012 through April 2013 with a group of patients diagnosed with a patent foramen ovale at the Hospital Angeles Pedregal in Mexico City. Permeability of the foramen and/ or the presence of atrial septal aneurysm (ASA) were confirmed in all patients. Other medical history of importance was looked into (age, sex, blood pressure, comorbidities, and the decision for a surgical or medical management). Thirteen patients were enrolled; 53.8% were admitted after having suffered an ischemic stroke and more than half of them had an associated atrial septal aneurysm. In 76.9% of patients a surgical management was chosen.
Results: Thirteen patients were included; mean age was of 48.6 years; only 4 patients were older than 55 years; 15.3% had history of ischemic stroke, thus surgical treatment was decided. In more than half of the sample (53.8%) atrial septal aneurysm was evidenced. In 76.9% surgical treatment was decided with device Amplatzer^®, without evidence of trans or postsurgery immediate complications. In 11 of the 13 patients their discharge was decided with anti-aggregation. A patient was discharged with factor Xa inhibitor, due to unknown medical preferences, and in 3 patients their discharge was decided only with medical treatment.
Conclusions: According to current guidelines, mechanical seal must be done after a second event or when there is the combination of patent foramen ovale and atrial septal aneurysm. Currently, cases should be individualized and the experience in the placement of mechanical devices should be taken into account, considering that sequelae after a cerebrovascular disease puts at risk the functionality and quality of life of patients. Likewise, the choice of anticoagulation or antiplatelete therapy should be evaluated with caution. The management of patent foramen ovale should prompt further debate.

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