Abstract
Il forame ovale pervio (PFO) è una variante anatomica caratterizzata dalla mancata fusione del septum I al septum II, che determina una comunicazione tra atrio destro e sinistro a livello della fossa ovale. L’incremento delle pressioni che si verifica in atrio sinistro alla nascita ne determina la chiusura entro il primo anno di vita. Nel 25% della popolazione tale chiusura non avviene e pertanto persiste una comunicazione tra i due atri. Ciò può comportare un transitorio shunt destro-sinistro in tutte quelle condizioni in cui la pressione atriale destra supera quella dell’atrio sinistro (per esempio, durante la manovra di Valsalva) e comportare il fenomeno dell’embolia paradossa. La presenza di un PFO è stata associata a diverse sindromi patologiche, tra le quali rivestono particolare importanza l’ictus criptogenetico, l’emicrania e l’embolia paradossa dei subacquei. Pertanto l’esercizio di sport subacquei con auto-respiratori è vietata ai portatori di PFO, mentre sono consentite tutte le altre attività sportive e le attività subacquee in apnea. L’interventistica non coronarica negli ultimi anni ha avuto un rilevante incremento in termini di popolarità, di attuabilità i risultati a breve e a medio-lungo termine sono in continuo miglioramento. In questo setting si inseriscono la chiusura percutanea del PFO, dell’auricola sinistra e il trattamento percutaneo della vasculopatia periferica (PTA o impianto di endoprotesi aortiche).
Al di là della ben accertata controindicazione all’esercizio degli sport subacquei con autorespiratori nei soggetti con PFO, in letteratura mancano ancora chiare indicazioni circa la pratica sportiva in soggetti sottoposti a interventistica non coronarica.
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Bibliografia
Hagen PT, Scholz DG, Edwards WD (1984) Incidence and size of patent foramen ovale during the first ten decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 59:17–20
Lamy C et al (2002) Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke 33:706–711
Del Sette M et al (1998) Migraine with aura and right-to-left shunt on transcranial Doppler: a case-control study. Cerebrovasc Dis 8:327–330
Wilmshurst P et al (1997) Patent foramen ovale and decompression illness. Spums J 27:82–83
Agnoletti G et al (2005) Obstructive sleep apnoea and patent foramen ovale: successful treatment of symptoms by percutaneous foramen ovale closure. J Interven Cardiol 18:393–395
Kerut EK et al (2001) Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol 38:613–623
Angeli S et al (2001) Very high prevalence of right-to-left shunt on transcranial Doppler in an Italian family with cerebral autosomal dominant angiopathy with subcortical infarcts and leukoencephalopathy. Eur Neurol 46:198–201
Sulek CA et al (1999) Cerebral microembolism diagnosed by transcranial Doppler during total knee arthroplasty: correlation with transesophageal echocardiography Anesthesiology 91:672–676
Homma S, Sacco RL (2000) Patent foramen ovale and stroke. Circulation 112: 1063–1072
Lechat P. et al (1988) Prevalence of patent foramen ovale in patients with stroke. NEJM 318:1148–1152
Lausanne Stroke Paradoxal Embolism Study Group (1996) Stroke ricorrence in patients with patent foramen ovale: the Lausanne study. Neurology 46:1301–1305
Windecker S, Wahl A, Nedeltchev K et al (2004) Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenetic stroke. J Am Coll Cardiol 44:750–758
Khairy P, O’Donnell CP, Landzberg MJ (2003) Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review. Ann Int Med 139:753–760
Wohrle J. Closure of patent foramen ovale after cryptogenetic stroke. Lancet 368:350–432.
Azarbal B, Tobis J et al (2005) Association of interatrial shunts and migraine headaches. J Am Coll Cardiol 45:489–492
Wilmshurst P, Nightingale S (2001) Relationship between migrane and cardiac right-to-left shunts. Clin Sci 100: 215–220
Germonpré P (2005) Patent foramen ovale and diving. Cardiol Clin 23:97–104
Honek T, Veselka J, Tomek A et al (2007) Paradoxical embolization and patent foramen ovale in scuba divers: screening possibilities]. Vnitr Lek. 53:143–146
Harrison D, Lloyd-Smith R, Khazei A et al (2005) Controversies in the medical clearance of recreational scuba divers: updates on asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale. Curr Sports Med Rep 4:275–281
King TD, Thompson SL, Steiner C et al (1976) Secundum atrial septal defect: nonoperative closure during cardiac catheterization. JAMA 23:2506–2509
Wahl A, Meier B (2009) Patent foramen ovale and ventricular septal defect closure. Heart 95:70–82
Krumsdorf U, Ostermayer S, Billinger K et al (2004) Incidence and clinical course of thrombus formation on atrial septal defect and patent foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol 43:302–309
Karen LF et al (2011) Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 42:1–50
Picchio FM, Colonna PL, Daliento L et al (2001) Società Italiana di Cardiologia Pediatrica. Criteri di valutazione della capacità lavorativa,idoneità al lavoro specifico, attitudine all’attività fisica e sportiva ed assi curabilità nel cardiopatico congenito. Ital Heart J Suppl 2:46–77
Graham TP Jr, Driscoll DJ, Gersony WM et al (2005) 36th Bethesda Conference Raccomendations for Competitive Athletes with Cardiovascular Abnormalities Task Force 2: Congenital Heart Disease. J Am Coll Cardiol 45:1326–1313
Helber U, Baumann R, Seboldt H et al (1997) Atrial septal defect in adults:cardiopulmonary exercise capacity before and 4 months and 10 years after defect closure. J Am Coll Cardiol 29:1345–1350
Warnes RG, Williams TM, Bashore JS et al. (2008) ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 118:e714–e833
Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S (2011) Safety of Percutaneous Left Atrial Appendage Closure: Results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF (PROTECT AF) Clinical Trial and the Continued Access Registry. Circulation 123:417–424
Mas JL, Trinquart L, Leys D et al (2008) EVA-3S investigators. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 7:885–892
Eckstein HH, Ringleb P, Allenberg JR et al (2008) Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol 7:893–902
Brott TG, Hobson RW, Howard G et al for the CREST Investigators (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23
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Tommasino, A., Trani, C. (2011). Altre indicazioni cliniche: la pratica sportiva in pazienti con forame ovale pervio e soggetti sottoposti a interventistica non coronarica. In: Cardiologia dello Sport. Springer, Milano. https://doi.org/10.1007/978-88-470-2352-9_26
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DOI: https://doi.org/10.1007/978-88-470-2352-9_26
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