Patent foramen ovale and the risk of paradoxical embolization of venous bubbles in divers – cave for foam sclerotization of varicose veins
Authors:
J. Honěk 1; T. Honěk 1; J. Januška 2; P. Šebesta 3; Š. Novotný 4; L. Šefc 5; J. Fiedler 1; M. Šrámek 6; M. Horváth 3; M. Parobková 7
Authors place of work:
Kardiologická klinika 2. LF UK a FN Motol, přednosta: Prof. MUDr. J. Veselka, CSc.
1; Kardiocentrum, Nemocnice Třinec Podlesí, a. s., primář: MUDr. M. Branny
2; Avicena – chirurgie, s. r. o., primář: Doc. MUDr. T. Honěk, CSc.
3; Hyperbarická komora a poradna pro potápěče, Kladno, primář: MUDr. Š. Novotný
4; Ústav patologické fyziologie 1. LF UK, přednosta: Prof. MUDr. E. Nečas, DrSc.
5; Neurologické oddělení, Nemocnice Kladno, primář: MUDr. L. Sobotková
6; Ústav speciálních služeb MVČR
7
Published in the journal:
Rozhl. Chir., 2012, roč. 91, č. 7, s. 378-380.
Category:
Original articles
Summary
Introduction:
Foam sclerotization of varicose veins may cause paradoxical embolization through patent foramen ovale (PFO). The aim of our study was to: 1) select an optimal screening method for the detection of PFO; 2) determine the prevalence of PFO in a non-selected population; and 3) test the risk of paradoxical embolization of venous bubbles in patients with PFO.
Materials and methods:
A diver after decompression is a suitable model for determining the risk of paradoxical embolization of venous gas bubbles. 329 Czech divers were screened for PFO. In a pilot study, we compared Transcranial Doppler Sonography (TCD) with Transesophageal Echocardiography (TEE) in 100 patients. TCD alone was used for further screening. In 31 divers with PFO, nitrogen bubbles were detected after simulated dives. Transthoracic Echocardiography (TTE) was used to detect venous bubbles in right-sided heart chambers; TTE and TCD were used to detect arterial bubbles. The right-to-left shunt was rated as non-significant (<20 arterial bubbles) or significant (≥20 arterial bubbles). Different decompression regimens were compared.
Results:
In the pilot study, TCD was compared with the gold standard in PFO detection – TEE. The negative predictive value of TCD was 100%, positive predictive value was 92%. Screening was performed in a total of 329 divers, PFO was detected in 85 (25%), significant R-L shunt in 45 (14%). In simulated dive to 50 m maximum depth, venous nitrogen bubbles were detected in 7/8 (88%) divers. In 6/8 (75%) divers, paradoxical embolization was confirmed – nitrogen bubbles were detected in the systemic circulation.
Conclusion:
PFO prevalence with significant R-L shunt was 14% in the non-selected population of Czech divers. Simulated dives indicate that PFO represents a risk factor for paradoxical embolization of gas bubbles. TCD is a suitable screening method for the detection of PFO and the evaluation of R-L shunt significance. These results are indicative of a possible high risk of paradoxical embolization of gas bubbles and the trombogenic substance in patients with a larger PFO and significant R-L shunt undergoing foam sclerotization of varicose veins.
Key words:
patent foramen ovale – foam sclerotization
Zdroje
1. Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984;59:17–20.
2. Honěk T, Veselka J, Tomek A et al. Foramen ovale patens jako příčina paradoxní embolizace u sportovních potápěčů. Cor Vasa 2006;48:286–288.
3. Honěk J, Januška J, Novotný Š et al. Detekce dusíkových bublin po simulovaném ponoru potápěčů s foramen ovale patens. Kdy doporučit katetrizační uzávěr? Interv Akut Kardiol. 2012;11: 108–111.
4. Torti SR, Billinger M, Schwerzmann M et al. Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale. Eur Heart J 2004;25:1014–1020.
5. Januška J. Paradoxní embolizace – diagnostika a léčba patent foramen ovale. Interv Akut Kardiol 2008;7:24–29.
6. Souteyrand G, Motreff P, Lusson JR et al. Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients. Eur J Echocardiography 2006;7:147–154.
7. Honěk T, Veselka J, Tomek A et al. Paradoxní embolizace při foramen ovale patens u potápěčů: možnosti screeningu. Vnitř Lék 2007;53(2):143–146.
8. Morrison N, Neuhardt DL, Rogers CL, McEown J, Morrison T, Johnson E, Salles-Cunha SX. Incidence of Side Effects Using Carbon Dioxide-Oxygen Foam for Chemical Ablation of Superficial Veins of the Lower Extremity. Eur J Vasc Endovasc Surg 2010;40:407–413.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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