Patent Foramen Ovale and Atrial Septal Defect

Patent Foramen Ovale and Atrial Septal Defect
Order 58906089
Patent Foramen Ovale and Atrial Septal Defect
The following figure shows a pictorial diagram of the
heart with the patent foramen ovale (PFO) shown by
an arrow.Which of the following statements correctly
identifies other anatomic structures (more than one
answer may be correct)?
Cranial
F
A
E
PFO
RV
Caudal
LV
D
B
G
C
(A) Left atrium
(B) Right atrium
(C) Septum secundum
(D) Septum primum
(E) Inferior vena cava
(F) Right upper pulmonary vein
(G) Left subclavian vein
2 Current indications for closure of a PFO may include
all of the following, except:
(A) Recurrent paradoxical embolism
(B) Hypoxemia due to right-to-left shunting
(C) Pulmonary hypertension
(D) Decompression illness
(E) Orthodeoxy–platypnea syndrome
Patent Foramen Ovale and Atrial Septal Defect
3 Which of the following statements describing the
United States regulations regarding PFO closure is
true?
(A) The CardioSEAL closure device is U.S. Food and
Drug Administration (FDA)-approved for PFO
closure
(B) Several devices have previously had humanitarian device exemption approval for patients with
recurrent paradoxical embolism on warfarin
anticoagulation, but this approval has recently
been revoked
(C) Off-label PFO closure can be performed with
any device as long as the physician recommends
it and the patient consents
(D) The Institutional Review Board (IRB) approval
is needed for any PFO procedure
4 In which of the following patients might percutaneous closure be a reasonable therapeutic option?
(A) A 45-year-old man who has had a presumed
embolic stroke with no obvious risk factors
for stroke. His magnetic resonance imaging
254
Patent Foramen Ovale and Atrial Septal Defect 255
(MRI) shows a recent as well as a remote
infarct in two distinct areas. His transesophageal
echocardiogram (TEE) shows a PFO and an
atrial septal aneurysm
(B) A 75-year-old man with recurrent transient
ischemic attacks (TIAs) despite aspirin therapy.
His TTE shows mild mitral stenosis and a PFO
(C) A 42-year-old woman who suffers a stroke and
has a PFO. Her workup reveals lupus and a
positive anticardiolipin antibody
(D) A 46-year-old man with lung cancer who suffers
a stroke and has a deep vein thrombolysis (DVT)
in his right leg
5 Which of the following choices is considered to
increase the likelihood of recurrent stroke in patients
with a paradoxical embolism through a PFO?
(A) Large shunt
(B) Residual shunt after percutaneous closure
(C) Prominent Eustachian valve and right atrium
stands
(D) Lipomatous septum secundum
(E) Event occurring on warfarin anticoagulation.
6 The cine image reproduced in the following figure in
a patient with PFO illustrates which of the following
findings and treatment strategies?
(A) A sizing balloon used to document the absence
of a significant left-to-right shunting
(B) A sizing balloon used to stretch or tear a long
‘‘tunnel’’
(C) A percutaneous occluding device being deployed by balloon inflation
(D) Pulmonary vein isolation to prevent atrial
fibrillation (AF) before PFO closure
7 Which of the following is true about this echocardiographic image of a markedly positive bubble study
for right-to-left shunting through a PFO?
(A) It is an intracardiac echo (ICE) image with the
right atrium on top, left atrium below, head to
the right, and feet to the left
(B) It is an ICE image with the left atrium on top
and right atrium below
(C) It is an ICE image with right atrium on top, left
atrium below, head to left, and feet to right
(D) It is a TEE image with left atrium on top
8 Which of the following are possible explanations
for the low rates of recurrent stroke and TIA after
percutaneous device closure?
(A) The devices prevent thrombi from crossing the
PFO
(B) Most trials of device closure have enrolled
younger patients than in trials of medical therapy for stroke (selection bias)
(C) Concomitant medical therapy
(D) All of the above
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