Abdelsayed Nardine, Parza Kevin, Faris Mohamed
Department of Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA.
Cureus. 2022 Jul 10;14(7):e26722. doi: 10.7759/cureus.26722. eCollection 2022 Jul.
Patent foramen ovale (PFO) occurs in about 25% of the population. PFO closure has been shown to decrease the risk of stroke in patients with recurrent strokes as compared to those treated with medical therapy alone, with more benefit in those with larger PFO sizes. Percutaneous PFO closure, although minimally invasive, does carry surgical risks, which must also be taken into account. We present a case of a 31-year-old female presenting with a left middle cerebellar artery (MCA) stroke and persistent deficits who was found to have both a PFO and presumed fibroelastoma on her aortic valve. She was treated with aspirin and apixaban and advised to follow up with cardiothoracic surgery once she recovered from her stroke for ultimate PFO closure and removal of the fibroelastoma. Unfortunately, she presented again less than one month later with recurrent cerebrovascular accidents (CVA) requiring urgent PFO closure. Our case stresses the importance of tools such as the Risk of Paradoxical Embolism (RoPE) score index when determining treatment plans for patients with PFO, and possible confounding factors such as the presence of an aortic valve fibroelastoma.
卵圆孔未闭（PFO）在约25%的人群中存在。与单纯接受药物治疗的患者相比，已证实卵圆孔未闭封堵可降低复发性卒中患者的卒中风险，对于卵圆孔较大的患者益处更大。经皮卵圆孔未闭封堵术虽为微创手术，但确实存在手术风险，这一点也必须予以考虑。我们报告一例31岁女性患者，因左侧小脑动脉（MCA）卒中及持续性神经功能缺损就诊，检查发现其既有卵圆孔未闭，主动脉瓣上还疑似有纤维弹性瘤。她接受了阿司匹林和阿哌沙班治疗，并被告知从中风恢复后前往心胸外科进行随访，以便最终封堵卵圆孔并切除纤维弹性瘤。不幸的是，不到一个月后她再次出现复发性脑血管意外（CVA），需要紧急封堵卵圆孔。我们的病例强调了在为卵圆孔未闭患者制定治疗方案时，诸如反常栓塞风险（RoPE）评分指数等工具的重要性，以及诸如主动脉瓣纤维弹性瘤存在等可能的混杂因素。
