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PubMed1976

A safe technique for closure of the recurrent patent ductus arteriosus.

In an early series of 73 operations for patent ductus arteriosus, closure was by the triple ligation method. Over a short period, recurrence of patency was observed in 2 cases and after that the technique of division and suture rather than ligation became standard. For closure of the recurrent ductus, a modification of the usual technique is necessary to minimize danger of injury to the recurrent nerve and the great vessels. A safe method was devised which involves an intrapericardial approach to the superior aspect of the ductus and dissection inferiorly which avoids denudation of the aorta. This technique was used with satisfaction in 6 cases of recurrent patent ductus arteriosus.

Adult↗

PubMed2004

Patent foramen ovale in cryptogenic stroke: current understanding and management options.

There is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalva-inducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.

Adult↗

PubMed2002

Recurrent inner ear decompression sickness associated with a patent foramen ovale.

Isolated inner ear injuries occurring during shallow scuba dives are an uncommon manifestation of decompression sickness in recreational divers. We describe a patient who presented with the typical symptoms of inner ear involvement after 2 independent dives within the decompression limits. The diver reported symptoms of unilateral (right-sided) hearing loss, tinnitus, and vertigo after dives to 35 and 50 m. After treatment with hyperbaric oxygen, his symptoms completely resolved. To confirm the hypothesis of inner ear decompression sickness (IEDCS), we examined the patient for a right-to-left shunt by cranial Doppler ultrasound and found a patent foramen ovale. The existence of a patent foramen ovale is suspected to be a risk factor for developing neurological symptoms of decompression sickness. There was no evidence of any other risk factors, so we suggest that the relevant right-to-left shunt in our patient may have been the predisposing factor that caused the inner ear symptoms during his scuba dive.

Adult↗

PubMed2006

Patent foramen ovale and high-altitude pulmonary edema.

CONTEXT: Individuals susceptible to high-altitude pulmonary edema (HAPE) are characterized by exaggerated pulmonary hypertension and arterial hypoxemia at high altitude, but the underlying mechanism is incompletely understood. Anecdotal evidence suggests that shunting across a patent foramen ovale (PFO) may exacerbate hypoxemia in HAPE. OBJECTIVE: We hypothesized that PFO is more frequent in HAPE-susceptible individuals and may contribute to more severe arterial hypoxemia at high altitude. DESIGN, SETTING, AND PARTICIPANTS: Case-control study of 16 HAPE-susceptible participants and 19 mountaineers resistant to this condition (repeated climbing to peaks above 4000 m and no symptoms of HAPE). MAIN OUTCOME MEASURES: Presence of PFO determined by transesophageal echocardiography, estimated pulmonary artery pressure by Doppler echocardiography, and arterial oxygen saturation measured by pulse oximetry in HAPE-susceptible and HAPE-resistant participants at low (550 m) and high altitude (4559 m). RESULTS: The frequency of PFO was more than 4 times higher in HAPE-susceptible than in HAPE-resistant participants, both at low altitude (56% vs 11%, P = .004; odds ratio [OR], 10.9 [95% confidence interval {CI}, 1.9-64.0]) and high altitude (69% vs 16%, P = .001; OR, 11.7 [95% CI, 2.3-59.5]). At high altitude, mean (SD) arterial oxygen saturation prior to the onset of pulmonary edema was significantly lower in HAPE-susceptible participants than in the control group (73% [10%] vs 83% [7%], P = .001). Moreover, in the HAPE-susceptible group, participants with a large PFO had more severe arterial hypoxemia (65% [6%] vs 77% [8%], P = .02) than those with smaller or no PFO. CONCLUSIONS: Patent foramen ovale was roughly 4 times more frequent in HAPE-susceptible mountaineers than in participants resistant to this condition. At high altitude, HAPE-susceptible participants with a large PFO had more severe hypoxemia. We speculate that at high altitude, a large PFO may contribute to exaggerated arterial hypoxemia and facilitate HAPE.

Adult↗

PubMed1980

Left atrial electrograms recorded through the patent foramen ovale.

The presence of a patent foramen ovale allows direct recording of a left atrial (LA) electrogram. Three patients are reported in whom simultaneous high right atrial (HRA), coronary sinus (CS), and direct LA electrograms were obtained. In two patients with normal surface ECG P waves the direct LA lead depolarized before the CS or low RA. The HRA to LRA and HRA to CS conduction times were similar to those reported previously. In a patient with a prolonged surface ECG P wave, the direct LA electrogram occurred late and after low RA depolarization. Recording LA electrograms through a patent foramen ovale is a useful technique, and these defects should be sought in all patients undergoing electrophysiological study.

Aged↗

PubMed2002

Infective endocarditis resulting from CardioSEAL closure of a patent foramen ovale.

Patent foramen ovale and atrial septal aneurysm are associated with an increased risk of cryptogenic stroke and recurrent thromboembolic events. Percutaneous closure is a therapeutic option to medical therapy and surgical closure. We present the first case of endocarditis associated with a CardioSEAL device closing a patent foramen ovale.

Adult↗

PubMed2004

Patented antiinflammatory plant drug development from traditional medicine.

Patents secured on antiinflammatory plant drugs derived from 38 plants are reviewed. An attempt has been made to compare the modern and traditional use of plant drugs and to establish the relevance of folk claims in developing modern drugs. The role of plant botanicals such as polysaccharides, terpenes, curcuminoids, alkaloids, etc. in alleviating inflammatory diseases including arthritis, rheumatism, acne skin allergy and ulcers is highlighted. Chemicals that alleviate swelling are derived from plants including grape, boswellia, turmeric, devil's claw and some essential oils such as clove, eucalyptus, rosemary, lavender, mint, myrrh, millefolia and pine have been patented and used as mixed formulations. Plants containing polysaccharides are the most potent in curing inflammatory diseases.

Anti-Inflammatory Agents↗

PubMed2001

Patent foramen ovale complicated by paradoxical embolism and brain infarct in a patient with advanced ovarian cancer.

BACKGROUND: Recent investigations of patients with cerebral and peripheral arterial emboli of unknown cause suggest that paradoxical embolism through a patent foramen ovale might be responsible for more arterial embolic events than previously realized. CASE: A 60-year-old woman with advanced ovarian cancer presented with sudden onset of expressive aphasia and right upper hemiplegia postoperatively. A patent foramen ovale diagnosed by echocardiography with contrast combined with the presence of thrombosis in her right femoral vein leads us to speculate that her stroke was secondary to a paradoxical embolism. CONCLUSION: Paradoxical embolism should be considered in the differential diagnosis of ovarian cancer patients with embolic stroke and it may be appropriate to include a cardiac echo as part of the diagnostic evaluation.

Brain Infarction↗

PubMed1996

Cranial disjunction and visual failure in a slit ventricle syndrome with patent shunt.

A 6.5-year-old child who received a shunt at 3 weeks of age for triventricular hydrocephalus related to his congenital toxoplasmosis developed symptoms of intracranial hypertension and papilloedema. Computed tomographic scan demonstrated slit ventricles. The shunt device was shown to be patent on isotope transit study. Spontaneously the cranial sutures widened and headaches disappeared, but loss of vision occurred and did not reverse despite optic nerve sheath fenestration. We suspect that a rapid drop in intracranial pressure played a role in the pathogenesis of our patient's blindness. This possible complication should be taken into account when calvarial expansion is planned in a patient with an intracranial hypertension syndrome with papilloedema in the presence of slit ventricles and a patent shunt.

Blindness↗

PubMed1991

Patent ductus venosus.

A patent ductus venosus has been reported on only two previous occasions. Both involved adults who presented with recurrent bouts of encephalopathy. We present the case of an infant with complex congenital heart disease and multiple other abnormalities, in whom a patent ductus venosus was an incidental finding at necropsy. The etiology of this condition and the options for management are discussed.

Congenital Abnormalities↗

PubMed2003

Off-pump redo coronary artery bypass grafting from descending aorta to the posterolateral area through a left thoracotomy in patients with a patent internal thoracic artery graft.

The patients were a 73-year-old man (Case 1) and 56-year-old man (Case 2) who developed angina pectoris and heart failure. Case 2 showed chronic renal failure on hemodialysis. These patients showed posterolateral myocardial ischemia with a patent internal thoracic artery graft to the left anterior descending artery. Left ventricle ejection fraction was 29% and 33%, respectively. Catheter intervention was unsuccessful, so we performed revascularization from the descending aorta to coronary arteries with saphenous vein grafts via a left thoracotomy using an off-pump technique. In case 2, proximal anastomosis was constructed with the Symmetric aortic connector. This procedure appeared to be a very safe and useful method as an option for redo coronary artery bypass grafting in the posterolateral area in patients with patent old grafts and poor left ventricular function.

Aged↗

PubMed1999

Long-term results of the fenestrated Fontan operation. Progress of patients with patent fenestrations.

The fenestrated Fontan operation was introduced as a modification of the "completed" Fontan operation for patients with high risk factors, and low operative mortality has frequently been reported. However, use of the umbrella device is now restricted, and this procedure should be performed without subsequent closure. In this paper, we review our clinical experience with this procedure and discuss ongoing problems. Sixteen patients (4 tricuspid atresia and 12 other cardiac anomalies including 5 cases of univentricular heart) underwent the fenestrated Fontan operation (7 atriopulmonary and 9 total cavopulmonary connection). All of them have some risk factors for a completed Fontan operation. There were three early deaths of the 16. Two experienced an anticipated thromboembolic accident, one of which involved the pulmonary aspect while the other involved the arterial aspect. Patients who survived the operation have progressed well and have a clinical status of New York Heart Association class I, with the exception of one late death due to congestive heart failure. There have been no thromboembolic accidents in this group during the late follow-up period. Spontaneous closures of the fenestrations were noted in two patients. The late mean Qp/Qs value in patients with patent fenestrations was 0.80 +/- 0.1, SaO2 was 88.8 +/- 5.6%, and right atrial pressure was 9.7 +/- 3.8 mmHg. No major problems have been encountered in patients with a patent fenestration over extended periods. A modified Fontan operation to fit a permanently open fenestration may be considered as a final surgical option for certain high-risk patients.

Adolescent↗

PubMed2006

Allantoic cyst: a prenatal clue to patent urachus.

A patent urachus, which is typically diagnosed as leakage from the umbilicus postnatally, can present as an allantoic cyst in the umbilical cord antenatally. We report a case of a patent urachus with an allantoic cyst diagnosed via fetal MR imaging at 24 weeks' gestation. Early detection allowed for appropriate counseling and prompt corrective surgery after birth.

Adolescent↗

PubMed2001

Patent ductus venosus: diagnosis by MR angiography.

We report a 15-year-old boy with patent ductus venosus in whom the diagnosis was made by MR angiography. A patent ductus venosus Arantii is a rare form of portosystemic shunt. Only a few cases have been reported in adults and children. The diagnosis is usually made by US and digital subtraction angiography. In our patient, the diagnosis was first made by MR angiography. This demonstrates the excellent diagnostic potential of the method in paediatric patients.

Adolescent↗

PubMed1999

Patent medicines for the treatment of genitourinary diseases.

The present article addresses the nineteenth-century advertising of patent medicines in America, sold to "cure" diseases of the kidney and bladder, the "loss of manhood", and "debilitating conditions of the generative system." Most of the proprietary remedies made extravagant claims of effectiveness concerning a wide variety of ailments, and some claimed to cure every disease. Examples of promotional excesses demonstrate how the public was persuaded to buy a kaleidoscope of largely useless and occasionally harmful patent nostrums. The ephemera considered became a part of the history of medicine related to urology.

Advertising↗

PubMed2001

Interventional stent implantation in a child with patent ductus venosus and pulmonary hypertension.

UNLABELLED: We report on the rare case of a 4-year-old boy with patent ductus venosus and pulmonary hypertension presenting with progressive fatigue, tachypnoea at rest and tachycardia. Cardiac catheterisation revealed suprasystemic pressure in the pulmonary arteries with severely elevated pulmonary vascular resistance. In order to reduce the diameter of the ductus venosus, a stent was implanted interventionally, which closed, as expected, spontaneously 2 years later. Pulmonary arterial pressure and pulmonary vascular resistance decreased significantly and the general condition of the boy improved dramatically. CONCLUSION: To the best of our knowledge, this represents the first report of successful interventional stent occlusion of a patent ductus venosus associated with severe pulmonary hypertension. The future will tell whether this intervention is curative or represents a bridging procedure for subsequent liver transplantation.

Child, Preschool↗

PubMed1999

Persistent patent pseudolumen of ruptured dissecting aneurysm involving the posterior inferior cerebellar artery after proximal clipping.

In the majority of cases of ruptured vertebral artery dissecting aneurysm after proximal clipping, the dissected pseudolumen persists for a very short time, probably because re-entry from the pseudolumen is minimal. Recent reports have indicated a high risk of rebleeding of dissecting aneurysms involving the posterior inferior cerebellar artery (PICA) after proximal clipping, probably due to excessive retrograde flow from the distal vertebral artery into both the PICA and the pseudolumen. We describe an extremely rare case of ruptured dissecting aneurysm involving the PICA with persistent patent pseudolumen after proximal clipping. The present case was assumed to have developed a moderate retrograde flow just sufficient to maintain the patent pseudolumen in the chronic stage. Neointimal formation is suggested to be a possible mechanism by which the pseudolumen is stabilized for a very long period.

Aortic Dissection↗

PubMed2003

Minimally invasive closure of patent foramen ovale through port-access surgery.

We present here our experience of patent foramen ovale closure through a mini-invasive surgical technique. With the new surgical platform termed Heartport System, it is possible to install extra-corporeal circulation and to obtain cardioplegic arrest of the heart with endovascular techniques. This allows the operation of closure to be entirely performed through a micro-thoracotomy (Port-access surgery) in the right 4th intercostal space. Sixty-one patients underwent this surgical correction and seventeen of them (26%) had a diagnosis of patent foramen ovale, 12 with an history of cerebrovascular accidents. They are all alive and well after a mean follow-up of 16 months, with no recurrence of the inter-atrial communication and free from new neurological events. The post-operative course was uneventful with patients discharged on postoperative day 4. This technique shows a 100% efficacy, minimise surgical trauma, allows a quick recovery and offers excellent cosmetic results with no scarring. We believe that this procedure must be regarded as the "golden standard" for the closure of atrial septal defects

Cardiac Catheterization↗