| Titel | Paradoxical embolism, migraine, and cardiac shunt closure |
|---|---|
| Auteur | Luermans, J.G.L.M. |
| Promotor | Hemel, N.M. van; Budts, W.I.H.L.; Plokker, H.W.M.; Post, M.C. |
| Universiteit | University Utrecht |
| Datum | 2010-02-02 |
| Trefwoord(en) | paradoxical embolism, cryptogenic stroke, migraine, patent foramen ovale, atrial septal defect, right-to-left shunt, transcatheter closure |
| Taal | Engels |
| Type | proefschrift |
| Uitgever | Utrecht University |
| Samenvatting | A cardiac right-to-left shunt through a patent foramen ovale (PFO) or an atrial septal defect (ASD) allows paradoxical embolism and seems to be associated with cryptogenic stroke and migraine. The transcatheter closure of inter-atrial shunts with an “umbrella” device is nowadays widely practised in the treatment of patients with symptomatic shunts. Shunt closure has also been associated with a decrease in the prevalence of migraine. Aims of this thesis were to study the efficacy and safety of transcatheter PFO and ASD closure, using different types of closure devices, and to evaluate the effect of transcatheter PFO and ASD closure on the occurrence of migraine. Firstly, the efficacy and safety of transcatheter PFO closure in patients with previous paradoxical embolic events was examined. PFO closure was found to be effective in the secondary prevention of paradoxical embolic events, with low recurrence rates of stroke and TIA and low complication rates, using various types of closure devices. However, a worse outcome in elderly was found, suggesting that either percutaneous PFO closure might be less beneficial in elderly or that they constitute a high risk population. Secondly, the safety and efficacy of transcatheter ASD closure in adults was examined. Transcatheter ASD closure was found to be an effective procedure in these patients with a high succes rate of closure and an improvement of symptoms. Overall, a low complication rate was found with this procedure, however the occurrence of complications was related to the type and the size of the closure device used. Thirdly, the haemodynamic effects of transcatheter ASD and PFO closure were evaluated, using non-invasive finger pressure measurements. After PFO closure none of the haemodynamic parameters changed significantly. However, the transcatheter ASD closure resulted in an immediate increase in systolic and mean blood pressure and an increase in stroke volume. Fourthly, the effect of transcatheter PFO closure on the occurrence of migraine in patients with a symptomatic PFO was examined in a prospective observational design. Six months after PFO closure, a decrease in the prevalence of migraine, especially migraine with aura, was found in this patient population. Fifthly, the effect of transcatheter ASD closure on the occurrence of migraine was prospectively studied. Twelve months after ASD closure, a decrease in the prevalence of migraine, especially migraine with aura, was found in this patient population. In conclusion, the percutaneous closure of a symptomatic inter-atrial shunt is effective and safe. PFO closure seems to be related with less beneficial outcome in elderly with previous paradoxical embolic events. Shunt closure might be associated with an improvement of migraine. It is, however, too early to recommend primary percutaneous shunt closure in the treatment of migraine and large randomized trials are needed. |
| Publicatie | http://igitur-archive.library.uu.nl/dissertations/2010-0121-200419/UUindex.html |
| Persistent Identifier | URN:NBN:NL:UI:10-1874-39357 |
| Metadata | XML |
| Repository | Universiteit Utrecht |
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