BACKGROUND AND PURPOSE: Recurrent cerebrovascular events are frequent in medically treated patients with patent foramen ovale (PFO), but it still remains unclear whether PFO is a causal or an incidental finding. Further uncertainty exists on whether the size of functional shunting could represent a potential risk factor. The aim of the present study was to evaluate if the presence of PFO is associated with an increased risk of recurrent stroke or transient ischemic attack and to investigate further if this relationship is related to the shunt size. METHODS: We conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of all available prospective studies reporting recurrent cerebrovascular events defined as cryptogenic stroke and transient ischemic attacks in medically treated patients with PFO diagnosed by echocardiography or transcranial sonography. RESULTS: We identified 14 eligible studies including a total of 4251 patients. Patients with stroke with PFO did not have a higher risk of the combined outcome of recurrent stroke/transient ischemic attack (risk ratio=1.18; 95% confidence interval=0.78-1.79; P=0.43) or in the incidence of recurrent strokes (risk ratio =0.85; 95% confidence interval=0.59-1.22; P=0.37) in comparison with stroke patients without PFO. In addition, PFO size was not associated with the risk of recurrent stroke or transient ischemic attack. We also documented no evidence of heterogeneity across the included studies. CONCLUSIONS: Our findings indicate that medically treated patients with PFO do not have a higher risk for recurrent cryptogenic cerebrovascular events, compared with those without PFO. No relation between the degree of PFO and the risk of future cerebrovascular events was identified.

• Klíčová slova
• foramen ovale, patent, ischemic attack, transient, stroke, transcranial Doppler ultrasonography, transesophageal echocardiography,
• MeSH
• cévní mozková příhoda diagnóza   epidemiologie   terapie   MeSH
• foramen ovale apertum diagnóza   epidemiologie   terapie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• recidiva MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• systematický přehled MeSH

OBJECTIVES: This paper sought to evaluate the occurrence of decompression sickness (DCS) after the application of a patent foramen ovale (PFO) screening and risk stratification strategy. BACKGROUND: PFO is associated with an increased risk of DCS. Recently, transcatheter closure was reported to reduce DCS occurrence in divers with a high-grade shunt. However, to date, there are no data regarding the effectiveness of any PFO screening and risk stratification strategy for divers. METHODS: A total of 829 consecutive divers (age 35.4 ± 10.0 years, 81.5% men) were screened for PFO by means of transcranial color-coded sonography in the DIVE-PFO (Decompression Illness Prevention in Divers with a Patent Foramen Ovale) registry. Divers with a high-grade PFO were offered either catheter-based PFO closure (the closure group) or advised conservative diving (high grades). Divers with a low-grade shunt were advised conservative diving (low grades), whereas those with no PFO continued unrestricted diving (controls). A telephone follow-up was performed. To study the effect of the screening and risk stratification strategy, DCS occurrence before enrollment and during the follow-up was compared. RESULTS: Follow-up was available for 748 (90%) divers. Seven hundred and 2 divers continued diving and were included in the analysis (mean follow-up 6.5 ± 3.5 years). The DCS incidence decreased significantly in all groups, except the controls. During follow-up, there were no DCS events in the closure group; DCS incidence was similar to the controls in the low-grade group (HR: 3.965; 95% CI: 0.558-28.18; P = 0.169) but remained higher in the high-grade group (HR: 26.170; 95% CI: 5.797-118.160; P < 0.0001). CONCLUSIONS: The screening and risk stratification strategy using transcranial color-coded sonography was associated with a decrease in DCS occurrence in divers with PFO. Catheter-based PFO closure was associated with a DCS occurrence similar to the controls; the conservative strategy had a similar effect in the low-grade group, but in the high-grade group the DCS incidence remained higher than in all other groups.

• Klíčová slova
• decompression sickness, paradoxical embolism, patent foramen ovale, risk stratification, screening,
• MeSH
• dekompresní nemoc * diagnostické zobrazování   epidemiologie   etiologie   MeSH
• dospělí MeSH
• foramen ovale apertum * komplikace   diagnostické zobrazování   epidemiologie   MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• registrace MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Patent foramen ovale (PFO), male sex, age, and body mass index (BMI) were all identified as potential risk factors of decompression sickness (DCS). It has been debated whether PFO might cause unprovoked DCS (i.e. without violation of decompression procedure) due to paradoxical embolization of venous gas emboli. To date, there are no data on the incidence or risk factors of unprovoked DCS. This study sought to evaluate the risk factors of unprovoked DCS in recreational divers. METHODS: A total of 489 consecutive divers were screened for PFO between January 2006 and January 2014 by means of transcranial Doppler. All patients were prospectively included in the study registry. Survival analysis techniques were used to assess for risk factors for unprovoked DCS. Age, sex, BMI, PFO presence, and grade were analyzed. The total sum of dives was used as a measure of time. RESULTS: The group performed a total of 169,411 dives (mean 346±636). Thirty-six (7%) of the divers suffered from an unprovoked DCS. The frequency of PFO was 97.2% in divers with a history of unprovoked DCS and 35.5% in controls (p<0.001). There was no difference in sex, age, BMI, or total number of dives between the respective groups. In the adjusted Cox proportional hazards model, PFO grade 3 was a major risk factor for unprovoked DCS; there was a slight protective effect of increasing age. CONCLUSIONS: We demonstrated that a high-grade PFO was a major risk factor for unprovoked DCS in recreational scuba divers.

• Klíčová slova
• Decompression sickness, Patent foramen ovale, Risk factors,
• MeSH
• dekompresní nemoc etiologie   MeSH
• dospělí MeSH
• foramen ovale apertum komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• potápění škodlivé účinky   MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• registrace MeSH
• rizikové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH

Patent foramen ovale (PFO) is associated with an increased risk of decompression sickness (DCS) in divers that results from a paradoxical embolization of nitrogen bubbles. The number of scuba divers worldwide is estimated in the millions, and the prevalence of PFO is 25%-30% in adults. It is interesting that despite these numbers, many important issues regarding optimal screening, risk stratification, and management strategy still remain to be resolved. Recently published data suggest the possible effectiveness of both PFO closure and conservative diving measures in preventing arterial gas embolization. This review aims to introduce the basic principles of physiology and the pathophysiology of bubble formation and DCS, summarize the current literature on PFO and diving, and review the possibilities of diagnostic workup and management.

• MeSH
• celosvětové zdraví MeSH
• dekompresní nemoc komplikace   MeSH
• dospělí MeSH
• foramen ovale apertum epidemiologie   etiologie   MeSH
• incidence MeSH
• lidé MeSH
• potápění škodlivé účinky   MeSH
• rekreace * MeSH
• rizikové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

• Klíčová slova
• DUCTUS ARTERIOSUS/surgery *,
• MeSH
• ductus arteriosus chirurgie   MeSH
• lidé MeSH
• otevřená tepenná dučej * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• echokardiografie transezofageální MeSH
• fatální výsledek MeSH
• foramen ovale apertum komplikace   diagnostické zobrazování   MeSH
• lidé MeSH
• senioři MeSH
• srdeční selhání etiologie   MeSH
• tromboembolie komplikace   diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• Klíčová slova
• Conservative dive profile, Decompression sickness, Paradoxical embolism, Patent foramen ovale,
• MeSH
• dekompresní nemoc diagnóza   etiologie   prevence a kontrola   MeSH
• dospělí MeSH
• foramen ovale apertum komplikace   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pilotní projekty MeSH
• potápění škodlivé účinky   fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

A child undergoing routine transcatheter patent arterial duct closure developed severe transient ischemic changes in the electrocardiogram (Pardee waves) while the aortic retention skirt of the Amplatzer™ Duct Occluder was pulled against the duct orifice. The occluder was then released, and the delivery system was pulled back to inferior caval vein which led to electrocardiogram normalisation. Aortic root angiography showed a single coronary artery originating from the right sinus of Valsalva with the left coronary stem wedged behind the posterior aspect of the right ventricular outflow tract. We believe that the left coronary artery was compressed while applying tension on the occluder delivery system.

• Klíčová slova
• Patent arterial duct, coronary anomaly, myocardial ischemia, transcatheter closure,
• MeSH
• CT angiografie MeSH
• echokardiografie MeSH
• elektrokardiografie * MeSH
• ischemická choroba srdeční diagnóza   etiologie   patofyziologie   MeSH
• kardiochirurgické výkony škodlivé účinky   metody   MeSH
• lidé MeSH
• otevřená tepenná dučej diagnóza   chirurgie   MeSH
• peroperační komplikace * MeSH
• předškolní dítě MeSH
• septální okluder škodlivé účinky   MeSH
• srdeční katetrizace škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Patent foramen ovale is a persisting communication between the left and right atrium, present in approximately 25% of population, usually asymptomatic. Under normal conditions there is either no blood flow or a hemodynamically nonsignificant left-to-right shunt between the atria. However, increased right atrium pressure, as it is in pulmonary embolism, can make PFO a right-to-left shunt and poses a risk of paradoxical systemic embolism, including the risk of ischemic stroke. Here we report a case of a patient presenting with venous thromboembolism provoked by a recent polytrauma. We identified a large thrombus stuck in patent foramen ovale - an impending paradoxical embolism. Both surgical intervention and systemic thrombolysis were contraindicated so the patient was administered an anticoagulation treatment with unfractionated heparin and warfarin. By frequent echocardiography we were able to monitor complete resolution of the thrombus by 6 months from the diagnosis, with no systemic embolism.

• Klíčová slova
• Pulmonary embolism, anticoagulation, impending paradoxical embolism, patent foramen ovale, pulmonary embolism,
• MeSH
• foramen ovale apertum * komplikace   diagnostické zobrazování   MeSH
• heparin MeSH
• lidé MeSH
• paradoxní embolie * komplikace   diagnostické zobrazování   MeSH
• plicní embolie * diagnostické zobrazování   etiologie   MeSH
• trombóza * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• heparin MeSH

• Klíčová slova
• DUCTUS ARTERIOSUS/surgery *, VECTORCARDIOGRAPHY *,
• MeSH
• ductus arteriosus chirurgie   MeSH
• otevřená tepenná dučej * MeSH
• vektorkardiografie * MeSH
• Publikační typ
• časopisecké články MeSH