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Translate this page into:

Letter to Editor
Cardiac Critical Care
8 (
2
); 116-117
doi:
10.25259/JCCC_61_2023

Central Retinal Artery Occlusion Secondary to Paradoxical Embolism Across a Patent Foramen Ovale

Department of Cardiac Anesthesia, Institute of Critical Care and Anaesthesiology, Medanta the Medicity, Gurugram, Haryana, India
Department of Interventional Cardiology, Medanta Heart Institute, Medanta the Medicity, Gurugram, Haryana, India
Corresponding author: Dr. Chinmaya Nanda, MD, FIACTA, Senior Consultant, Department of Cardiac Anesthesia, Medanta the Medicity, Sector 38, Gurugram, Haryana, India. nandachinu@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Nanda C, Banerjee S, Mehta Y, Rawat SK, Chouhan NS. Central Retinal Artery Occlusion Secondary to Paradoxical Embolism Across a Patent Foramen Ovale. J Card Crit Care TSS. 2024;8:116-7. doi: 10.25259/JCCC_61_2023

Dear Editor,

A 21-year-old male was referred to our hospital for the closure of the patent foramen ovale (PFO). The patient had a history of sudden painless loss of vision in the right eye two months back. The ocular examination was suggestive of central retinal artery occlusion (CRAO). Electrocardiogram, computed tomography (CT) scan of the head and neck, magnetic resonance imaging brain, and Holter monitoring were unremarkable. Venous Doppler of the lower limb showed no evidence of deep vein thrombosis. Transesophageal echocardiography (TEE) showed a small (PFO) with a left to right shunt seen on Color Doppler interrogation. The PFO was closed percutaneously using Amplatzer septal occluder #12.

CRAO is uncommon in young adults. It is usually associated with systemic diseases such as collagen vascular disorders, malignancies, intracardiac anomalies, and coagulopathy.[1,2] CRAO due to embolization has been reported following left ventricular assist device implantation, coronary artery bypass grafting, carotid endarterectomy, and carotid stenting.[3,4] An atrial septal defect is essentially a left-to-right shunt. Embolic cerebrovascular accidents can occur due to paradoxical embolism across a PFO following a Valsalva maneuver, such as coughing or excessive straining. The PFO was closed to prevent recurrent strokes and loss of vision in the other eye.[5] In case of sudden onset vision loss in one eye, there should be suspicion of paradoxical embolism across a PFO.

PFO is a normal variation seen in 25% of the population and should not be considered pathological. Sometimes, the septum primum and secundum do not close completely, and a small oblique cleft remains. This opening is named probe patent PFO and is around 0.2–0.5 mm in dimension and does not allow intracardiac shunting. A PFO is either simple or of complex type. Complex PFOs are those that have a long tunnel length, multiple openings on the left atrial side or the atrial septal is aneurysmal. Excessively thickened septum secundum (≥10 mm), presence of Eustachian ridge/valve, or Chiari network and opening of the angle between PFO and inferior vena cava <10° are also considered complex PFO. Complex PFO is more prone to develop cryptogenic strokes.[6] PFO is essentially a left-to-right or bidirectional shunt, never purely a right-to-left shunt. TEE is very helpful in diagnosing the PFO, and injection of agitated saline and Valsalva maneuver increases the sensitivity of diagnosis. All physicians working in the emergency ward or intensive care unit must be aware that PFO is a potential cause of cryptogenic stroke and needs evaluation in that direction.

Ethical approval

The Institutional Review Board approval is not required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship

Nil.

References

  1. , , , . Transthoracic Echocardiography in Young Patients with Acute Retinal Arterial Obstruction. RECO Study Group. Retinal Emboli of Cardiac Origin Group. Can J Ophthalmol. 1997;32:38-41.
    [Google Scholar]
  2. , , , , , . Central Retinal Artery Occlusion Associated with Atrial Septal Defect: A Case Report. J Lumbini Med Coll. 2019;7:34-6.
    [CrossRef] [Google Scholar]
  3. , , , , , , et al. Retinal Embolization after Carotid Endarterectomy and Stenting for Carotid Artery Stenosis. J Clin Neurosci. 2015;22:1298-302.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , . Perioperative Retinal Artery Occlusion: Risk Factors in Cardiac Surgery from the United States National Inpatient Sample 1998-2013. Ophthalmology. 2017;124:189-96.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , , , . Central Retinal Artery Occlusion Associated with Patent Foramen Ovale: A Case Report and Literature Review. Arq Bras Oftalmol. 2021;84:494-8.
    [CrossRef] [PubMed] [Google Scholar]
  6. , , , , , , et al. Assessment of Morphology of Patent Foramen Ovale with Transesophageal Echocardiography in Symptomatic and Asymptomatic Patients. J Stroke Cerebrovasc Dis. 2015;24:1282-6.
    [CrossRef] [PubMed] [Google Scholar]

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