1/22. Biatrial myxoma resembling an interatrial clot in transit on echocardiogram.A 47-year-old man had an embolic stroke. Transesophageal echocardiography showed biatrial, elongated, mobile masses that appeared interconnected via a patent foramen ovale. echocardiography did not distinguish between an interatrial clot in transit and an atypical biatrial myxoma. Surgical resection and subsequent histopathologic examination identified the mass as a biatrial myxoma. This case identifies a limitation of echocardiography in the diagnosis of cardiac myxoma.- - - - - - - - - - ranking = 1keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
2/22. Transcranial doppler detection of fat emboli.BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. methods: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications.- - - - - - - - - - ranking = 1keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
3/22. neurologic manifestations of cerebral air embolism as a complication of central venous catheterization.OBJECTIVE, patients, AND methods: A severe case of cerebral air embolism after unintentional central venous catheter disconnection was the impetus for a systematic literature review (1975-1998) of the clinical features of 26 patients (including our patient) with cerebral air embolism resulting from central venous catheter complications. RESULTS: The jugular vein had been punctured in eight patients and the subclavian vein, in 12 patients. Embolism occurred in four patients during insertion, in 14 patients during unintentional disconnection, and in eight patients after removal and other procedures. The total mortality rate was 23%. Two types of neurologic manifestations may be distinguished: group A (n = 14) presented with encephalopathic features leading to a high mortality rate (36%); and group B (n = 12) presented with focal cerebral lesions resulting in hemiparesis or hemianopia affecting mostly the right hemisphere, with a mortality rate as high as 8%. In 75% of patients, an early computed tomography indicated air bubbles, proving cerebral air embolism. Hyperbaric oxygen therapy was performed in only three patients (12%). A cardiac defect, such as a patent foramen ovale was considered the route of right to left shunting in 6 of 15 patients (40%). More often, a pulmonary shunt was assumed (9 of 15 patients; 60%). For the remainder, data were not available. CONCLUSION: When caring for critically ill patients needing central venous catheterization, nursing staff and physicians should be aware of this potentially lethal complication.- - - - - - - - - - ranking = 1keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
4/22. Cerebral embolization presenting as delayed, severe obtundation in the postanesthesia care unit after total hip arthroplasty.Catastrophic neurologic events occur rarely postoperatively and must be diagnosed quickly. A 63-year-old woman who had undergone uneventful total hip arthroplasty experienced obtundation after admission to the postanesthesia care unit. Cranial magnetic resonance imaging revealed multiple lesions consistent with ischemia or infarction, and fat cerebral embolism was diagnosed. We describe the numerous complications that may occur in patients in the postanesthesia care unit and review the differential diagnosis of altered mental status in such patients. Paradoxical cerebral fat embolization must be considered in the differential diagnosis of altered mental status after pelvic or long bone fracture or lower extremity major joint replacement, and this condition may occur despite normal pulmonary function and no patent foramen ovale or right-to-left intracardiac shunt. magnetic resonance imaging with T2-weighted sequences is the cranial imaging study of choice for early evaluation of patients with sudden multifocal neurologic deficits and suspected fat embolism syndrome.- - - - - - - - - - ranking = 1keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
5/22. Patent foramen ovale and brain microembolization during scoliosis surgery in adolescents.STUDY DESIGN: A case series is reported. OBJECTIVE: To improve understanding of the potential mechanisms associated with cerebral microemboli during scoliosis surgery in adolescents. SUMMARY OF BACKGROUND DATA: Paradoxical cerebral fat microembolization during scoliosis surgery has been associated with right-to-left shunting through an undetected patent foramen ovale. The prevalence of this cardiac defect in the adult population may be as high as 15% to 25%. Although the clinical relevance of this embolic phenomenon during scoliosis surgery has not been investigated, a few reports have documented its fatal consequences. It has been suspected in some patients with postoperative reduced visual function, particularly after complex instrumented fusions. methods: Bilateral transcranial Doppler (2 MHz) was used to monitor cerebral microemboli in the right and left middle cerebral arteries during spinal instrumentation and fusion in four patients. Additionally, transthoracic or transesophageal echocardiography incorporating pulse and color Doppler (3.5-5 MHz) and a contrast test was used in these patients to detect atrial shunts. RESULTS: Intraoperative transcranial Doppler monitoring detected high rates of cerebral microemboli associated with the presence of an atrial communication in two adolescents. In two additional patients with no detected brain microembolization, echocardiographic examination indicated the absence of an atrial shunt. CONCLUSION: The study findings suggest that unrecognized atrial communications in adolescents undergoing scoliosis surgery contribute to higher rates of Doppler-detected cerebral microemboli than those found in adolescents without this congenital defect.- - - - - - - - - - ranking = 2.7933398586212keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
6/22. Cerebral embolism resulting from a transvenous pacemaker catheter inadvertently placed in the left ventricle: a report of two cases confirmed by echocardiography.BACKGROUND: Transvenous pacemaker catheters may be placed unintentionally into the left ventricle. This can lead to thromboembolic complications. methods AND RESULTS: We report two cases where pacemaker catheters placed unintentionally in the left ventricle via a patent foramen ovale resulted in cerebrovascular accidents. The malpositioned pacemaker catheters were demonstrated by transthoracic and transesophageal echocardiography. In both patients, no further embolic events have occurred after treatment, which in one case consisted of pacemaker catheter removal and in the other case, anticoagulation. CONCLUSION: echocardiography can be useful to confirm inadvertent left ventricular pacemaker placement in patients with pacemakers who have cerebrovascular accidents.- - - - - - - - - - ranking = 1keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
7/22. Paradoxical cerebral arterial embolization of cement during intraoperative vertebroplasty: case report.Paradoxical cerebral embolism of cement occurred in a 78-year-old woman after cement-assisted transpedicular spinal fixation surgery. Multiple pulmonary emboli of polymethylmethacrylate precipitated pulmonary hypertension and right-to-left shunting into the systemic circulation through a patent foramen ovale. This rare complication occurred because of failure to recognize venous migration of cement during the procedure and the injection of multiple levels in one setting. Although this was an open procedure, the technical aspects were the same as for vertebroplasty and the precautions should be applied to percutaneous vertebroplasty.- - - - - - - - - - ranking = 1keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
8/22. Paradoxical air embolism from patent foramen ovale in scoliosis surgery.STUDY DESIGN: A case was reported in which paradoxical air embolism arose from the patent foramen ovale in scoliosis surgery. OBJECTIVES: To present a case of suspected paradoxical air embolism after scoliosis surgery. SUMMARY OF BACKGROUND DATA: Embolic accident during scoliosis surgery may be caused by air, thrombus, or fat. There is growing attention on patent foramen ovale involved in paradoxical embolism. The devastating consequences are caused by multiple artery occlusions. methods: Details of a recent documented neurologic complication (paraplegia, weakness of right arm, and blurry vision) after scoliosis surgery have been analyzed in medical publications. RESULTS: The surgical procedure was not imputed. The causative role of epidural catheter for analgesia was considered, but it is likely that a paradoxical embolism occurred in this case, based on the multifocal (cerebral and spinal) neurologic dysfunction, the evidence of cerebral ischemia (on computed tomography), and the presence of a patent foramen ovale (on postoperative transesophageal echocardiography). Although no intraoperative embolism detection was available, air embolism was highly suspected because there was no absolute argument to exclude cruor or fatty embolism. CONCLUSIONS: It is critical to detect a patent foramen ovale before surgery and cerebral embolization intraoperatively. This might permit ascertainment of the etiologic diagnosis in case of a complication in surgery for scoliosis.- - - - - - - - - - ranking = 8keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
9/22. Echocardiographically guided closure of a patent foramen ovale during pregnancy after recurrent strokes.BACKGROUND: stroke during pregnancy and puerperium is a severe complication that causes high morbidity and mortality. A patent foramen ovale (PFO) allowing paradoxical embolism is one identified risk factor. CASE: A 25-year-old pregnant woman with PFO suffered from recurrent cerebral embolism. To prevent recurrent cerebral embolism during pregnancy, delivery, and puerperium, interventional closure of the PFO was performed without fluoroscopy under echocardiographic guidance. The postinterventional course was uneventful. CONCLUSION: Percutaneous transvenous closure of a PFO during pregnancy is feasible without the use of fluoroscopy.- - - - - - - - - - ranking = 5keywords = foramen ovale, patent foramen ovale, patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
10/22. Intracardiac migration of nitinol TrapEase vena cava filter and paradoxical embolism.The nitinol TrapEase inferior vena cava filter is a new device for pulmonary embolism prophylaxis. No cases of filter migration or filter-related complications with this type of device have so far been described. We report a case of intracardiac migration of this filter in a patient with a patent foramen ovale, resulting in severe cardiogenic shock, cerebral and right arm paradoxical embolism. Surgical treatment, results, causes of these complications are discussed.- - - - - - - - - - ranking = 0.24686660274905keywords = patent foramen, ovale, foramen, patent (Clic here for more details about this article) |
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