RESUMEN
El foramen oval es una abertura natural entre las dos cavidades superiores del corazón (la aurícula derecha y la aurícula izquierda) que presenta el corazón de los bebés antes de nacer. Este se suele cerrar entre 6 meses y 1 año después del nacimiento del bebé. En un 25% de la poblacion se queda abierto.
Antes del nacimiento, el foramen oval permite que la mayoría de la sangre oxigenada que llega a la aurícula derecha desde la vena cava inferior entre en la aurícula izquierda y evita su paso en sentido opuesto ya que el
septum primum
se cierra contra el
septum secundum
, relativamente rígido. Después del nacimiento, normalmente el agujero oval se cierra y su válvula se fusiona con el septum primum, como consecuencia de ello el tabique interauricular se convierte en una división completa entre las aurículas. En el momento del nacimiento el incremento del flujo de sangre pulmonar causa que la presión de la aurícula izquierda supere la presión de la aurícula derecha, facilitando el cierre del foramen oval.
El FOP no produce síntomas a la mayoría de las personas. No obstante, puede originar varias complicaciones clínicas graves, principalmente por medio de embolias sistémicas. También ha sido asociado con la fisiopatología de diferentes enfermedades incluyendo migraña, enfermedad de descompresión, embolismo periférico causando infarto de miocardio y renal.
TRATAMIENTO
El cierre percutáneo del FOP se basa en una intervención introducida en 1975, 2 años antes de la primera angioplastia coronaria que tuvo lugar en 1977. Por primera vez se implantó por vía percutánea una prótesis de doble paraguas para cerrar un defecto del tabique auricular. El cierre no quirúrgico del FOP se introdujo en 1992 mediante una técnica parecida. Este procedimiento se ha convertido en uno de los más frecuentes en la cardiología intervencionista en adultos. Es la intervención basada en catéteres más segura y fácil del ámbito de la cardiología y puede proporcionar el mayor beneficio neto de todos en cuanto al balance riesgo-beneficio.
CLINIC CASE
A 28-year-old woman with no history of interest who went to the emergency room because she suddenly noticed ringing in the left ear with subsequent total hearing loss in this ear, immediately afterward evidence that she cannot see the right hemifield of the right eye (she insists that the perimetric defect was monocular), associated with inability to articulate language. This lasts for a few minutes and subsides, starting right after occipito-cervical headache and a feeling of instability without turning objects, which makes walking difficult, a clinical condition that persists in our assessment. In the directed interview, the patient denies sudden cervical movements or the sensation of sudden cervical pain associated with head movements. She also did not show a deficit in previous days.
Physical exploration:
Afebrile, BP 129/77 HR 66 SatO2 99% basal. NRL: conscious and alert, oriented in all 3 spheres, no dysarthria or dysphasic elements of language. Look centered, with MOEs conserved. No campimetric defects. No facial asymmetries. No sensitivity deficit tactile. The extremities do not give up in antigravity maneuvers, keeping BM 5/5. Slight decomposition of EID in heel-knee test, no toe-nose asymmetries. Not dysdiadachokinesia. In Romberg discreet rocking without lateropulsion. Cautious gait, with a slight increase in the base of support, without objectifying lateropulsion.
Laboratory tests:
GENERAL BIOCHEMISTRY: NORMAL
HEMOSTASIS: NORMAL
HEMATIMETRY: NORMAL
MIC-BLOOD-SERUM: NORMAL
DYSLIPEMIA STUDY – CVR: NORMAL
Ray Tests: BRAIN CT AND MRI ANGIO.
Area of hypersignal on T2 and Flair sequence of approximately 23 mm in diameter in hemisphere right cerebellar with restriction in the diffusion sequence in relation to acute infarction in vertebrobasilar territory. Other poorly defined and smaller foci with the same characteristics are observed in the left cerebellar hemisphere and small punctate lesions in the cerebellar vermix. At the supratentorial level, only a small focus of juxtacortical hypersignal was observed in the occipital lobe. Asymmetry of the venous sinuses, the transverse and left sigmoid being smaller, permeable.
Impression: Acute infarction in the right cerebellar hemisphere. Several foci of infarction in the cerebellar hemisphere left, vermix and left occipital. Probable embolic origin.
Other Tests: EDTC with bubbles: after an effective Valsalva maneuver, a «curtain» pattern (countless bubbles), on 1st-2nd beat.
TTE: PFO with a very brisk basal step and grade 2 with Valsalva. Fossa ovale aneurysm, with wide PFO. There is continuous spontaneous flow by left-right color Doppler. With the Valsalva maneuver, the movement of the aneurysm is reversed to the left and the tunnel is expanded, which reaches measuring almost 1cm with abundant passage of contrast towards the left atrium.
SUMMARY
The foramen ovale is a natural opening between the two upper chambers of the heart (the right atrium and the left atrium) that the heart of babies presents before birth. This usually closes between 6 months and 1 year after the baby is born. In 25% of the population it remains open. Before birth, the foramen ovale allows most of the oxygenated blood that reaches the right atrium from the inferior vena cava to enter the left atrium and prevents its passage in the opposite direction as the septum primum closes against the septum secundum. relatively stiff. After birth, the foramen ovale normally closes and its valve fuses with the septum primum, resulting in the interatrial septum becoming a complete division between the atria. At birth, increased pulmonary blood flow causes left atrial pressure to exceed right atrial pressure, facilitating closure of the foramen ovale.
FOP does not cause symptoms in most people. However, it can cause several serious clinical complications, mainly through systemic emboli. It has also been associated with the pathophysiology of different diseases including migraine, decompression sickness, peripheral embolism causing myocardial and renal infarction.
TREATMENT
Percutaneous PFO closure is based on an intervention introduced in 1975, 2 years before the first coronary angioplasty in 1977. For the first time, a double umbrella prosthesis was implanted percutaneously to close an atrial septal defect. Non-surgical PFO closure was introduced in 1992 using a similar technique. This procedure has become one of the most common in interventional cardiology in adults. It is the safest and easiest catheter-based intervention in cardiology and may provide the greatest net benefit of all in terms of risk-benefit balance.
BIBLIOGRAFIA
1.Drighil A, El Mosalami H, Elbadaoui N, Chraibi S, Bennis A.. Patent foramen ovale:a new disease? Int J Cardiol, 122 (2007), pp. 1-9
2.Pan M, Suárez de Lezo J, Medina A, Romero M, Segura J, Mesa D.. Tratamiento percutáneo de los aneurismas del septo interauricular. Rev Esp Cardiol, 58 (2005), pp. 222-6
3.M. Taramasso, F. Nietlispach, F. Maisano, B. Meier. Patent foramen ovale: Indications for closure and techniques. EuroIntervention, 17 (2016), pp. X7-X12
4.F. Nietlispach, B. Meier. Percutaneous closure of patent foramen ovale: an underutilized prevention? Eur Heart J., 37 (2016), pp. 2023-2028
5.T. King, N. Mills. Nonoperative closure of atrial septal defects. Surgery., 75 (1974), pp. 383-388
6. N.D. Bridges, W. Hellenbrand, L. Latson, J. Filiano, J.W. Newburger, J.E. Lock. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism.
Circulation., 86 (1992), pp. 1902-1908
7. Calvert PA, Rana BS, Kydd AC, Shapiro LM. Patent Foramen Ovale: anatomy, outcomes, and closure Nat Rev Cardiol. 2011;8:148–160.
8. Homma S, Sacco RL. Contemporary reviews in cardiovascular medicine: patent foramen ovale and stroke. Circulation. 2005;112:1063–72.
Categorías
Cardiología
,
Enfermería
,
Medicina de Urgencias
Etiquetas
caso clínico
,
cierre percutáneo del FOP
,
ictus isquémico
,
tratamiento
Subluxación atlanto axoidea por traumatismo en un paciente con artritis reumatoide
Cáncer vesicular biliar, incidencia, factores de riego, prevención y supervivencia