Ukponmwan Esosa U, Banga Sandeep, Kim Andrew G, Qintar Mohammed, Abela George
Internal Medicine, Michigan State University, East Lansing, USA.
Cardiology, Michigan State University, East Lansing, USA.
Cureus. 2023 Oct 12;15(10):e46895. doi: 10.7759/cureus.46895. eCollection 2023 Oct.
The foramen ovale serves as an opening between the right and left atria at the site of the fossa ovalis in the fetus during uterine life. During fetal life, it makes it possible for venous blood from the maternal placenta with oxygen and nutrients to bypass the immature fetal lung and get transported to the left side of the heart and onto the systemic circulation. This hole from the right to the left atrium is usually occluded at the time of birth or shortly after birth, due to increased pressures in the left-sided cardiac cavities associated with normal breathing during delivery or shortly afterwards. If the foramen ovale remains open and fails to fuse beyond the first year of life, it is known as a patent foramen ovale (PFO). PFO occurs when, during fetal life, the septum primum and secundum, which develop and overlap normally, fail to fuse at birth. This results in the persistence of communication between the right and left atria. Paradoxical embolism from the right to the left side of the heart can occur through a PFO, causing a cryptogenic stroke or embolic stroke of an undetermined source in an otherwise healthy adult. There was a debate on the long-term benefits of closure. However, data from the randomized evaluation of the recurrent stroke comparing PFO closure to established current standard of care treatment (RESPECT) trial and two randomized trials (patent foramen ovale closure or anticoagulants versus antiplatelet therapy to prevent stroke recurrence (CLOSE) and reduction by dutasteride of prostate cancer events (REDUCE)) have clarified that there is a benefit to closure. In this case report, we describe a patient who presented with cryptogenic stroke, the investigations, imaging modalities for diagnosis of PFO, and procedure for closure. We also describe long-term outcomes and management following closure.
卵圆孔在胎儿子宫内生活期间是位于卵圆窝处的左右心房之间的一个开口。在胎儿期，它使得来自母体胎盘富含氧气和营养物质的静脉血能够绕过未成熟的胎儿肺，被输送到心脏左侧并进入体循环。由于分娩时或分娩后不久正常呼吸导致左侧心腔压力升高，这个从右心房到左心房的孔通常在出生时或出生后不久就会闭合。如果卵圆孔在出生后第一年之后仍保持开放且未融合，就被称为卵圆孔未闭（PFO）。卵圆孔未闭发生在胎儿期，正常发育并重叠的原发隔和继发隔在出生时未能融合。这导致左右心房之间持续存在交通。通过卵圆孔未闭可能会发生从右心房到左心房的反常栓塞，在原本健康的成年人中引发不明原因的中风或来源不明的栓塞性中风。关于封堵的长期益处曾有过争论。然而，比较卵圆孔未闭封堵与现行既定标准治疗（RESPECT）试验以及两项随机试验（卵圆孔未闭封堵或抗凝剂与抗血小板治疗预防中风复发（CLOSE）和度他雄胺降低前列腺癌事件（REDUCE））的复发性中风随机评估数据已经明确表明封堵是有益的。在本病例报告中，我们描述了一名出现不明原因中风的患者、相关检查、用于诊断卵圆孔未闭的成像方式以及封堵手术。我们还描述了封堵后的长期结果和管理情况。
