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      Cierre de foramen oval permeable en un paciente militar: presentación de un caso y revisión de la literatura Translated title: Patent foramen ovale closure in a military patient: case presentation and revision of the literature

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          Abstract

          RESUMEN: Actualmente, la indicación más prevalente para el cierre de un foramen ovale permeable (FOP) es el ictus criptogénico. Sin embargo, en el ámbito militar coexisten varias circunstancias especiales (tácticas, médicas y periciales) que pueden generar la necesidad de un tratamiento del FOP, fuera del contexto de un ictus criptogénico. Presentamos el caso de un cierre de FOP en un paciente militar.

          Translated abstract

          SUMMARY: Currently, the most prevalent indication in order to close a patent foramen ovale is cryptogenic stroke. However, in the military environment, several special circumstances (tactical, medical and legal) may generate the need for a treatment outside the cryptogenic stroke context. We present a case of a patent foramen ovale closure in a military member.

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          Most cited references14

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          2020 ESC Guidelines for the management of adult congenital heart disease

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            Patent foramen ovale: a review of associated conditions and the impact of physiological size.

            Patent foramen ovale (PFO) is implicated in platypnea-orthodeoxia, stroke and decompression sickness (DCS) in divers and astronauts. However, PFO size in relation to clinical illness is largely unknown since few studies evaluate PFO, either functionally or anatomically. The autopsy incidence of PFO is approximately 27% and 6% for a large defect (0.6 cm to 1.0 cm). A PFO is often associated with atrial septal aneurysm and Chiari network, although these anatomic variations are uncommon. Methodologies for diagnosis and anatomic and functional sizing of a PFO include transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and transcranial Doppler (TCD), with saline contrast. Saline injection via the right femoral vein appears to have a higher diagnostic yield for PFO than via the right antecubital vein. Saline contrast with TTE using native tissue harmonics or transmitral pulsed wave Doppler have quantitated PFO functional size, while TEE is presently the reference standard. The platypnea-orthodeoxia syndrome is associated with a large resting PFO shunt. Transthoracic echocardiography, TEE and TCD have been used in an attempt to quantitate PFO in patients with cryptogenic stroke. The larger PFOs (approximately > or =4 mm size) or those with significant resting shunts appear to be clinically significant. Approximately two-thirds of divers with unexplained DCS have a PFO that may be responsible and may be related to PFO size. Limited data are available on the incidence of PFO in high altitude aviators with DCS, but there appears to be a relationship. A large decompression stress is associated with extra vehicular activity (EVA) from spacecraft. After four cases of serious DCS in EVA simulations, a resting PFO was detected by contrast TTE in three cases. Patent foramen ovales vary in both anatomical and functional size, and the clinical impact of a particular PFO in various situations (platypnea-orthodeoxia, thromboembolism, DCS in underwater divers, DCS in high-altitude aviators and astronauts) may be different.
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              European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism

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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                December 2021
                : 77
                : 4
                : 207-210
                Affiliations
                [5] Madrid orgnameHospital Central de la Defensa «Gómez Ulla» orgdiv1Servicio de Anestesiología y Reanimación
                [1] Madrid orgnameHospital Central de la Defensa «Gómez Ulla» orgdiv1Servicio de Cardiología
                [4] Madrid orgnameHospital Central de la Defensa «Gómez Ulla» orgdiv1Servicio de Cardiología
                [2] Madrid orgnameHospital Central de la Defensa «Gómez Ulla» orgdiv1Servicio de Cardiología
                [3] Madrid orgnameHospital Central de la Defensa «Gómez Ulla» orgdiv1Servicio de Cardiología
                Article
                S1887-85712021000400207 S1887-8571(21)07700400207
                10.4321/s1887-85712021000400007
                198c6f0f-07b6-442f-aea3-8738a71a83a5

                http://creativecommons.org/licenses/by/4.0/

                History
                : 13 January 2021
                : 05 April 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 4
                Product

                SciELO Spain

                Categories
                Comunicación Breve

                Foramen oval permeable,military,cardiology,Patent foramen ovale,militar,cardiología

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