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Abstract(s)
Introdução: O Foramen Oval Patente é uma anomalia congénita com elevada prevalência na população geral (≈25%). Na maioria dos casos é um achado incidental sem necessidade de tratamento. Porém, esta patologia foi associada a inúmeras condições patológicas major, nomeadamente, embolia paradoxal, enxaqueca, síndrome de descompressão em mergulhadores e síndrome de platipneia-ortodoxa. Esta anomalia é mais prevalente em pacientes com história de acidente vascular cerebral de idade inferior a 50 anos e parece não haver influências da raça ou sexo. Apesar de numerosos estudos terem sugerido uma forte associação entre foramen oval patente e a incidência de acidente vascular cerebral criptogénico, uma correlação clara ainda não foi estabelecida. As técnicas ecocardiográficas continuam a ser o exame gold-standard para fazer o diagnóstico. Apesar de ter sido proposto que a presença de foramen oval patente predispõe à ocorrência de eventos vasculares cerebrais, as terapias de prevenção para eventos isquémicos nestes pacientes ainda não foram testadas adequadamente, tornando difíceis eventuais comparações com o tratamento invasivo. A eleição de terapia farmacológica ou encerramento percutâneo tem sido objeto de intenso debate ao longo dos últimos anos.
Objetivo: Avaliar se o encerramento percutâneo deve ser considerado como modalidade terapêutica na abordagem do foramen oval patente.
Métodos: Na elaboração desta revisão, efetuou-se uma pesquisa bibliográfica baseada em documentos da base de dados eletrónica: PubMed, B-on, OvidSP e Science Direct.
Resultados: O tratamento permanece controverso e pode ser realizado com terapia farmacológica (antiagregantes plaquetares ou anticoagulantes), encerramento percutâneo ou encerramento cirúrgico.
Conclusões: O encerramento percutâneo do foramen oval tem sido proposto como uma opção terapêutica vantajosa para pacientes sintomáticos. Todavia, as evidências atuais não são suficientemente robustas para indicar que a oclusão percutânea do foramen oval patente é um tratamento mais seguro e eficaz do que o uso de anticoagulantes ou antiagregantes, na prevenção de eventos recorrentes.
ntroduction: Patent foramen ovale is a common congenital cardiac anomaly with a high prevalence in general population (≈25%). In most patients is an isolated finding with no need for special treatment. However, this entity has been associated to a number of major pathologic conditions, such as: systemic paradoxical embolism, migraine, decompression illness in divers and orthodeoxia-platypnea syndrome. It is more prevalent among patients with stroke under 50 years old and appears to have no difference between race or sex. Although numerous observational studies have suggested a strong association between patent foramen ovale and cryptogenic stroke, a clear relationship has not yet been proven. Echocardiographic techniques remain the principle mean for diagnosis. Even if patent foramen ovale is shown to predispose to stroke, medical therapies for stroke prevention in these patients have not been adequately tested, making comparisons with invasive treatment difficult. The preference between medical therapy and percutaneous device closure has been the subject of intense debate over the past several years. Objective: The aim of this review is to evaluate if percutaneous closure can be considered as a therapeutic approach to patent foramen ovale. Methods: For this literature review, a bibliographic search in PubMed, B-on, OvidSP and Science Direct databases was carried out. Results: Treatment choices remain controversial and may include medical therapy with antiplatelet agents or anticoagulants, percutaneous device closure or open surgical repair. Conclusion: Percutaneous closure of patent foramen ovale has been proposed as a therapeutic option for symptomatic patients. However, current evidence is not robust enough to evaluate if percutaneous closure of patent foramen ovale is safer and more effective than the use of anticoagulants and antiplatelet agents, in recurrent events prevention.
ntroduction: Patent foramen ovale is a common congenital cardiac anomaly with a high prevalence in general population (≈25%). In most patients is an isolated finding with no need for special treatment. However, this entity has been associated to a number of major pathologic conditions, such as: systemic paradoxical embolism, migraine, decompression illness in divers and orthodeoxia-platypnea syndrome. It is more prevalent among patients with stroke under 50 years old and appears to have no difference between race or sex. Although numerous observational studies have suggested a strong association between patent foramen ovale and cryptogenic stroke, a clear relationship has not yet been proven. Echocardiographic techniques remain the principle mean for diagnosis. Even if patent foramen ovale is shown to predispose to stroke, medical therapies for stroke prevention in these patients have not been adequately tested, making comparisons with invasive treatment difficult. The preference between medical therapy and percutaneous device closure has been the subject of intense debate over the past several years. Objective: The aim of this review is to evaluate if percutaneous closure can be considered as a therapeutic approach to patent foramen ovale. Methods: For this literature review, a bibliographic search in PubMed, B-on, OvidSP and Science Direct databases was carried out. Results: Treatment choices remain controversial and may include medical therapy with antiplatelet agents or anticoagulants, percutaneous device closure or open surgical repair. Conclusion: Percutaneous closure of patent foramen ovale has been proposed as a therapeutic option for symptomatic patients. However, current evidence is not robust enough to evaluate if percutaneous closure of patent foramen ovale is safer and more effective than the use of anticoagulants and antiplatelet agents, in recurrent events prevention.
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Keywords
Foramen oval patente Foramen oval patente - Encerramento percutâneo Foramen oval patente - Encerramento cirúrgico Foramen oval patente - Terapia farmacológica
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Universidade da Beira Interior