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Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
Trans-oesophageal echocardiography (TOE) has been reported to detect potential sources of embolism in around 40% of people with cryptogenic stroke (i.e. no apparent cause).16 However, the detected abnormality may be patent foramen ovale, which has an unclear role in the pathogenesis of stroke (see page 226), or aortic thrombus (the optimal management of which is unknown). TOE is unlikely to affect the management of many patients. There is a 0.2% risk of serious complications with this procedure (including hypoxia, gastrointestinal bleeding and arrhythmias).17 It is not a routine test but may have a role in a few selected people. Examples would include patients with suspected bacterial endocarditis or atrial myxoma.
Anatomy
Published in Alison Edwards, Antenatal Midwifery Skills, 2020
Four temporary structures:Ductus venosus – oxygenated blood is directed through this structure from the umbilical vein to the inferior vena cava.Foramen ovale – between the atria of the heart. This enables blood flow to bypass the pulmonary circulation.Ductus arteriosis – lies between the pulmonary arteries and the aorta. Aids the prevention of blood flow to the pulmonary circulation.Two hypogastric arteries – directs deoxygenated blood from the baby's lower extremities back through the umbilical arteries to the placenta.
Miscellaneous
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Foramen ovaleWhen: physiological and functional closure at birth. It takes months or even years for a complete closure with 25% of individuals having a patent foramen ovale.How: due to decreased flow from the right atrium and increased pressure in the left atrium.
Obesity in acute ischaemic stroke patients treated with intravenous thrombolysis therapy
Published in Neurological Research, 2023
Hongmin Li, Suliman Khan, Rabeea Siddique, Qian Bai, Yang Liu, Ruiyi Zhang, Yan Zhang, V. Wee Yong, Mengzhou Xue
Atrial fibrillation and flutter allow blood to stagnate, particularly in the left atrial appendage, which can allow thrombosis and subsequent embolism to the cerebral or systemic circulation. Permanent and paroxysmal atrial fibrillation increases the risk of cardioembolic ischaemic stroke [19]. The prevalence of atrial fibrillation is increasing with the aging and increasingly obese population. In utero, the cardiac foramen ovale allows the flow of placental oxygenated blood from the right to the left atrium. After birth, the increase in pressure on the left side of the heart closes the flap in most people but about 25% of individuals have a degree of residual patency (PFO) [20]. This patency creates a potential mechanism for paradoxical embolism, which could lead to ischaemic stroke. The importance of PFO in young adult stroke has been highlighted by the significant reduction in the risk of recurrent ischaemic stroke after endovascular closure of PFO [20, 21]. Bacterial endocarditis can cause septic emboli in the brain, leading to ischaemic stroke. Also, bacterial endocarditis presents difficulties for stroke treatment as it is associated with an increased risk of haemorrhagic transformation after thrombolysis owing to septic arteritis that weakens vessel walls. Surveillance for mycotic aneurysms (infected aneurysms) should be considered, as they can occur after endocarditis and can rupture, causing subarachnoid haemorrhage or ICH. Regions of segmental hypokinesis within the heart can occur following myocardial infarction, which can predispose to cardioembolic stroke [22].
Coronary Sinus Defect, Premature Restriction of Foramen Ovale and Cysto-Colic Peritoneal Band
Published in Fetal and Pediatric Pathology, 2023
The foramen ovale, a transitory atrial septum aperture that allows shunting of oxygenated placental blood to the left side of the heart and into systemic fetal circulation, is formed during the fourth week of gestation [10]. In most instances, the foramen ovale closes at birth or within the first three 3months of life [10]. Premature restriction or closure of foramen ovale, first described by Hansmann and Redel [11], is a deleterious condition occurring either as an isolated defect or in association with other congenital and cardiovascular anomalies [10]. As an isolated defect, restricted foramen ovale was identified in 23 cases by Uzun et al [12] who examined 1682 fetuses ultrasonographically, reporting an overall frequency of 1.4% [12]. All the restricted foramen ovale cases except for two were reported alive (21/1682 = 1.24%). Premature restriction or closure of foramen ovale in association with other anomalies was evaluated in an autopsy series by Levy et al [13] who analyzed 1,150 cases of congenital heart disease and found 10 with premature restriction/closure of foramen ovale reporting a frequency of 0.8%. While, Naeye and Blanc [14] reported 12 cases of prenatal narrowing or closure of the foramen ovale in their autopsy series, most other reports are anecdotal [15]. Literature suggests that majority of premature restriction or closure of foramen ovale are associated with hypoplastic left heart syndrome [3].
A Case of Transient Visual Field Defect following Administration of Pfizer-BioNTech COVID-19 Vaccine
Published in Ocular Immunology and Inflammation, 2022
Almila Sarıgül Sezenöz, Sirel Gür Güngör, Seda Kibaroğlu
Patent foramen ovale is a remnant of the fetal circulation, which normally closes within the first year of life. However, being the most common congenital heart defect, it persists as a cardiac communication between the left and right atria in 20% to 30% of the general adult population. In most people, it remains asymptomatic and therefore unnoticed for life.17 However, studies have shown that there is a possible connection with PFO and migraine and embolic events.17 In our case, our patient had a small PFO. The imaging studies we ran did not show any evidence of a possible embolus that might have predisposed by the presence of PFO. Therefore, we do not think that the patients’ complaints were directly linked to the PFO. Also, our patient has no personal or family history of migraine or aura before or after, and the one we report is the only episode, which has very close time link to vaccination. Also, the visual complaints of the patient lasted longer than a usual migraine aura. Based on these, we think that aura without migraine type headache or retinal migraine are less likely diagnoses in our case.