Korean Circulation Journal

  • 제47권5호
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  • Pages.776-785
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  • 2017
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  • 1738-5520(pISSN)
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  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
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Systematic Review of Treatment for Trapped Thrombus in Patent Foramen Ovale

  • Seo, Won-Woo (Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Sung Eun (Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Myung-Soo (Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Jun-Hee (Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Dae-Gyun (Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Han, Kyoo-Rok (Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Oh, Dong-Jin (Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine)
  • 투고 : 2016.08.12
  • 심사 : 2017.01.12
  • 발행 : 2017.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review. Subjects and Methods: A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively. Results: Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest. Conclusion: This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.

키워드

참고문헌

  1. Kent DM, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology 2013;81:619-25. https://doi.org/10.1212/WNL.0b013e3182a08d59
  2. Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984;59:17-20. https://doi.org/10.1016/S0025-6196(12)60336-X
  3. Konstantinides S, Geibel A, Kasper W, Olschewski M, Blumel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation 1998;97:1946-51. https://doi.org/10.1161/01.CIR.97.19.1946
  4. Meacham RR 3rd, Headley AS, Bronze MS, Lewis JB, Rester MM. Impending paradoxical embolism. Arch Intern Med 1998;158:438-48. https://doi.org/10.1001/archinte.158.5.438
  5. Fauveau E, Cohen A, Bonnet N, Gacem K, Lardoux H. Surgical or medical treatment for thrombus straddling the patent foramen ovale: impending paradoxical embolism? Report of four clinical cases and literature review. Arch Cardiovasc Dis 2008;101:637-44. https://doi.org/10.1016/j.acvd.2008.08.011
  6. Myers PO, Bounameaux H, Panos A, Lerch R, Kalangos A. Impending paradoxical embolism: systematic review of prognostic factors and treatment. Chest 2010;137:164-70. https://doi.org/10.1378/chest.09-0961
  7. Mattox KL, Feldtman RW, Beall AC Jr, DeBakey ME. Pulmonary embolectomy for acute massive pulmonary embolism. Ann Surg 1982;195:726-31. https://doi.org/10.1097/00000658-198206000-00008
  8. Yalamanchili K, Fleisher AG, Lehrman SG, et al. Open pulmonary embolectomy for treatment of major pulmonary embolism. Ann Thorac Surg 2004;77:819-23. https://doi.org/10.1016/j.athoracsur.2003.08.008
  9. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e419S-e496S. https://doi.org/10.1378/chest.11-2301
  10. Giannitsis E, Katus HA. Risk stratification in pulmonary embolism based on biomarkers and echocardiography. Circulation 2005;112:1520-1. https://doi.org/10.1161/CIRCULATIONAHA.105.566182
  11. Torbicki A, Galie N, Covezzoli A, et al. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol 2003;41:2245-51. https://doi.org/10.1016/S0735-1097(03)00479-0
  12. Casazza F, Bongarzoni A, Centonze F, Morpurgo M. Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism. Am J Cardiol 1997;79:1433-5. https://doi.org/10.1016/S0002-9149(97)00162-8
  13. Chartier L, Bera J, Delomez M, et al. Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients. Circulation 1999;99:2779-83. https://doi.org/10.1161/01.CIR.99.21.2779
  14. Rose PS, Punjabi NM, Pearse DB. Treatment of right heart thromboemboli. Chest 2002;121:806-14. https://doi.org/10.1378/chest.121.3.806

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  2. Saddle Pulmonary Embolus Caught in Transit across a Patent Foramen Ovale vol.2019, pp.None, 2017, https://doi.org/10.1155/2019/5747598
  3. Incidental finding of a mass fitting into a patent foramen ovale vol.17, pp.3, 2019, https://doi.org/10.1007/s12574-018-0391-7
  4. Biatrial Thromboembolism with Paradoxical Embolism Through Persistent Foramen Ovale vol.47, pp.3, 2017, https://doi.org/10.2478/amb-2020-0031
  5. Catheter-directed therapies for pulmonary embolism: considerations for patients with patent foramen ovale vol.51, pp.2, 2021, https://doi.org/10.1007/s11239-020-02189-2
  6. Management of straddling thrombus through patent foramen ovale complicating pulmonary embolism vol.14, pp.4, 2021, https://doi.org/10.1136/bcr-2020-240957
  7. Large Impending Paradoxical Embolus: Thrombotic Railroading from Right Ventricle to Left Ventricular Outflow vol.29, pp.3, 2017, https://doi.org/10.4250/jcvi.2020.0143
  8. Impending paradoxical embolism: about two cases. 3D echocardiographic imaging and discussion of treatment options vol.121, pp.6, 2017, https://doi.org/10.1080/00015458.2020.1728910