The Most Compelling Case I Have Ever Seen

By Bernhard Meier, MD

I have been a physician and cardiologist for almost 40 years. I have never come across a case as compelling as this one. A completely healthy young life is extinguished by an internal biological accident. The mechanism is crystal clear and 100% preventable. Moreover, the prevention consists in an outpatient procedure that may take less than 30 minutes in a catheterization laboratory with local anesthesia and with the patient walking out of the laboratory on foot to engage in any physical activity including sport a couple of hours later. Yes, it entails a device placed in the heart for the rest of a life but, no, the device will not cause harm and will not need replacement later. “Never” is a word that is not compatible with nature or medicine. There is, of course, a risk with PFO (patent foramen ovale) closure. Atrial fibrillation may ensue because of the device, but this is typically limited to a few patients already at the brink of atrial fibrillation. The device may erode a free wall and be life-threatening. This risk occurs in probably less than 1 per 1,000 patients and the net benefit pays for it, albeit the patient concerned sort of pays the dues of the others not concerned.

 autopsy4Figure 4B. Autopsy findings show large myocardial infarction involving the anterolateral and septal segments of the left ventricle.

The case presented is also meant to expand the inexcusably unidirectional attention to the PFO as a possible stroke cause to the PFO as a cause for paradoxical embolism to other organs. The heart with a blocked coronary artery is the most common victim after the brain. Lastly, albeit not pertinent to this case, it has to be emphasized that the PFO is a threat not only to healthy people. Many a neurologist will only think of the PFO as a stroke cause if the patient is otherwise healthy, meaning that he suffered a so-called cryptogenic stroke. On the contrary, the PFO itself gets more dangerous as people get sicker, simply because more venous thrombosis occurs, the prerequisite for paradoxical embolism.

Professor Bernhard Meier, MD is the Chairman of Cardiology at the University Hospital Bern in Bern, Switzerland.

Death by Patent Foramen Ovale in a Soccer Player   Thomas Pilgrim, MD, Bernhard Meier, MD, Ahmed A. Khattab, MD J Invasive Cardiol 2013;25(3):162-164


PFO and Cryptogenic Stroke: Finding Closure  Srihari Naidu, MD

To Close or Not to Close: PFO, Sex and Cerebrovascular Events Toby Ferguson, MD, Lauren H. Sansing, MD, Howard Herrmann, MD, Brett Cucchiara, MD

Percutaneous Device Closure of Patent Foramen Ovale Using the Premere Occlusion Device: Initial Experience, Procedural, and Intermediate-Term Results Nick J. Collins, FRACP, Rachael Hatton, FRACP, Kevin Ng, FRACP, Rohan Bhagwandeen, FRACP, John Attia, PhD, Chris Oldmeadow, PhD, Rohan Jayasinghe, PhD

Frequency of Atrial Tachyarrhythmias Following Transcatheter Closure of Patent Foramen Ovale Jamshid Alaeddini, MD, Georges Feghali, MD, Stephen Jenkins, MD, Stephen Ramee, MD, Christopher White, MD, Freddy Abi-Samra, MD

Left Main Coronary Stent Positioning Using Rapid Transcoronary Pacing  Crochan J. O’Sullivan, MB, BCh and Bernhard Meier, MD

Temporary transcoronary unipolar pacing is a validated simple, effective, and safe alternative to temporary transvenous pacing of the right ventricle for the treatment of relevant bradyarrhythmias complicating percutaneous coronary intervention. We describe the use of rapid transcoronary pacing to aid precise placement of a stent in the left main coronary artery bifurcation.

Accidental Closure of the Left Upper Pulmonary Vein With an Amplatzer Atrial Septal Defect Fabien Praz, MD, Marc Carlier, MD, Bernhard Meier, MD

We report the clinical outcome of a 46-year-old man referred for percutaneous closure of an atrial septal defect under transthoracic echocardiographic and fluoroscopic guidance, whose upper left pulmonary vein was erroneously obliterated using an Amplatzer atrial septal defect occluder. Various medical conditions have been associated with pulmonary vein stenosis including dyspnea on exertion or at rest, cough, and hemoptysis. However, there were no short- or long-term symptoms in this patient.

Frugal Angioplasty: Still an Option After 30 Years  Bernhard Meier, MD

Coronary angioplasty was not the first interventional procedure in cardiology but it clearly launched the discipline called interventional cardiology as we know it today. These storms in a teacup could, however, have called us back to reason that, yes, we should do the interventions but, no, we should not fall victim to the temptation of overdoing things. This article discusses several cases illustrating that interventional cardiology can do complex things with rather frugal techniques and materials

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