Don’t ever have this kind of “mindset”!

Author: Gao Shasha, attending physician of Zhengzhou Central Hospital affiliated to Zhengzhou University

Reviewer: Jin Xiaozhu, deputy chief physician, Zhengzhou Central Hospital affiliated to Zhengzhou University

Nana, 21, is a junior student in her prime. One morning, when she woke up, she suddenly found that she could not lift her left arm or stand on her left leg, which frightened her and her roommate. Her roommate sent her to the Zhengzhou Central Hospital affiliated to Zhengzhou University near the school.

Figure 1 Copyright image, no permission to reprint

The hospital immediately activated the stroke treatment green channel for Nana and urgently performed a magnetic resonance imaging (MRI) on her. The results showed "acute cerebral infarction in the right thalamus and occlusion of the intracranial large arteries." Because Nana missed the best time for stroke thrombolysis, the second-line interventional doctor chose the most suitable intra-arterial thrombectomy for Nana. The operation was very successful, and Nana's left fingers could move before she got off the operating table. Nana is a young and energetic young person, why did she suddenly suffer a stroke? The neurologist arranged a bubble test combined with right heart acoustic angiography for her, considering "patent foramen ovale", and the subsequent transesophageal echocardiogram results further confirmed the diagnosis of patent foramen ovale.

Figure 2 Copyright image, no permission to reprint

1. What is patent foramen ovale?

The foramen ovale is a small hole in the septum between the left and right atria, which usually closes on its own one year after birth. If it still does not close after the age of three, it is considered a patent foramen ovale. Patent foramen ovale is a congenital heart structural abnormality, and having this "heart eye" is not a good thing!

2.What are the symptoms of patent foramen ovale?

The incidence of patent foramen ovale is very high, and most cases have no obvious symptoms after the onset of the disease. When patients with patent foramen ovale are in a state of strenuous exercise or emotional excitement, the heart will beat faster, which will lead to increased pressure in the right atrium, causing the blood in the heart to be shunted from right to left, causing some blood clots, bubbles and other substances contained in the blood to be transported to the brain blood vessels without being filtered by the lungs, causing symptoms such as migraine, dizziness, fatigue, etc., which have been proven to induce stroke. Therefore, early diagnosis and treatment of patent foramen ovale are critical.

3. How to diagnose patent foramen ovale?

Transesophageal echocardiography combined with right heart echocardiography is the "gold standard" imaging method for diagnosing patent foramen ovale. Right heart echocardiography is widely used to diagnose or exclude intracardiac or intrapulmonary right-to-left shunt-related diseases. Transesophageal ultrasound can clearly observe the location, shape, marginal atrial septum length of the patent foramen ovale, and measure the resting diameter and opening diameter of the patent foramen ovale.

4. How to treat patent foramen ovale?

(1) Drug treatment: including the use of antiplatelet drugs and anticoagulants, but they can only prevent stroke and have no therapeutic effect.

(2) Interventional treatment: This is the best way to treat patent foramen ovale. By puncturing the femoral vein at the base of the thigh, a catheter is inserted into the left atrium, and an occluder umbrella is placed to complete the occlusion.

(3) Surgery: Open chest surgery can effectively treat patent foramen ovale. However, open chest surgery carries greater risks and trauma, and is prone to postoperative complications.

References

[1] Chen Jingwan, Luo Danyue, Wang Xidan, et al. Application value of transcranial Doppler bubble test in screening ischemic stroke with patent foramen ovale [J]. Chinese Journal of Ultrasound in Medicine, 2021, 37(1): 46-49.

［2］Yan Weina, Liang Yanyin, Wu Weiwei, et al. Diagnostic value of transthoracic and transesophageal echocardiography and right heart echocardiography for patent foramen ovale［J］． Journal of Qingdao University Medical College, 2020, 56(3): 352-354．

[3] Yuan Zhongrui, Xie Ming, Li Wenjun, et al. Application of right heart acoustic contrast bubble test combined with intracranial microemboli in screening for cerebral infarction in patients with patent foramen ovale [J]. Biomedical Engineering and Clinic, 2021, 25(6): 693-697.

[4] Feng Kun, Deng Yun, Wang Huijuan, et al. Application progress of ultrasound technology in the detection of right-to-left shunt in patent foramen ovale [J]. Journal of Clinical Cardiology, 2019, 35 (7): 590-594.

[5] Zhou Fang, Sheng Yanhui, Yang Rong, et al. The value of transcranial Doppler ultrasound bubble test in the diagnosis of patent foramen ovale and evaluation of closure efficacy [J]. Journal of Nanjing Medical University (Natural Science Edition), 2021, 41(11): 1659-1662.