The confounding caused by pulmonary shunts did not end there. In another patient who had a contrast echocardiogram at RBH and in whom a PFO could not be crossed, the interventional cardiologist performed a transseptal puncture ie, perforated the atrial septum in order to implant a STARFlex device. That was not disclosed in the paper in Circulation. In another from the RBH, the atrial septum was crossed with great difficulty using a fine coronary angioplasty wire and the size of the hole was too small to measure.
Defects of those sizes are very unlikely to have clinical significance. At the end of the analysis period, 65 patients ie, the 74 randomised to STARFlex implantation minus the nine withdrawn had a contrast echocardiogram by the implanting cardiologists. They reported that four had a significant residual shunt.
Recordings of 64 of the contrast echocardiograms were sent to me for review. One contrast echocardiogram could not be found. I reported that 28 records were of such poor quality that it is impossible to exclude a significant residual shunt. In 15, I could see no evidence of a significant residual shunt.
Twenty-one recordings showed a significant residual shunt and I reported that 13 were atrial ie, residual shunts across a PFO , 5 were pulmonary, and in 3 cases I was uncertain whether the shunts were atrial or pulmonary. As a result, the role of shunting in migraine with aura remains uncertain. Migraine with aura and right-to-left shunt on transcranial doppler: a case-control study.
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Headache Journal. International Headache Academy. International Headache Society. Katherine Hamilton. Lifestyle Changes. Migraine in Adolescents.
Migraine Mavens. Migraine with Aura. There are still many questions that should be addressed in the migraine population in collaboration with neurologists. Transesophageal echocardiography or at least intracardiac echography should be used to guide the procedure. He got his start in journalism at …. Effect of residual interatrial shunt on migraine burden after transcatheter closure of patent foramen ovale.
J Am Coll Cardiol Intv. Noble S. PFO closure and migraine: does residual shunt matter? Stay up-to-date with breaking news, conference slides, and topical videos covering the spectrum of CVD. Join our newsletter! Register today! News Daily News. A residual shunt after closure was associated with a lower likelihood of improvement in a retrospective study. By Todd Neale. Created with Sketch. February 04, Published online December 1, Institute for Value-Based Medicine.
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