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At least 127 records · Page 7

Patent foramen ovale and paradoxical systemic embolism: a bibliographic review

A patent foramen ovale (PFO) has been reported to be an important risk factor for cardioembolic cerebrovascular accidents through paradoxical systemic embolization, and it provides one potential mechanism for the paradoxical systemic embolization of venous gas bubbles produced after altitude or hyperbaric decompressions. Here, we present in a single document a summary of the original findings and views from authors in this field. It is a comprehensive review of 145 peer-reviewed journal articles related to PFO that is intended to encourage reflection on PFO detection methods and on the possible association between PFO and stroke. There is a heightened debate on whether aviators, astronauts, and scuba divers should go through screening for PFO. Because it is a source of an important controversy, we prefer to present the findings in the format of a neutral bibliographic review independent of our own opinions. Each cited peer-reviewed article includes a short summary in which we attempt to present potential parallels with the pathophysiology of decompression bubbles. Two types of articles are summarized, as follows. First, we report the original clinical and physiological findings which focus on PFO. The consistent reporting sequence begins by describing the method of detection of PFO and goal of the study, followed by bulleted results, and finally the discussion and conclusion. Second, we summarize from review papers the issues related only to PFO. At the end of each section, an abstract with concluding remarks based on the cited articles provides guidelines.

NASA Discipline Environmental Health↗

Industry Needs Fulfilled by Patented NASA PS300 Solid Lubricant Technology

In 1999, the NASA Glenn Research Center was awarded a patent (#5866518) for a new high-temperature solid lubricant coating material, PS300. A combination of wear-resistant metals and ceramics with solid lubricant additives, PS300 reduces friction and wear in sliding contacts from below ambient to over 650 C. This lubricant is an outgrowth of over three decades of high-temperature tribological research and was specifically developed as a shaft lubricant to protect foil air bearings used in Oil-Free turbomachinery, like gas turbines. Foil bearings are lubricated by air at high speeds but experience sliding and wear during initial startup and shut down when a lubricating film of air has not yet developed. PS300 shaft coatings have successfully lubricated foil bearings for over 100 000 cycles without wearing out.

DellaCorte, Christopher↗

Incidence and Size of Patent Foramen Ovale During the First 10 Decades of Life: An Autopsy Study of 965 Normal Hearts

The incidence and size of the patent foramen ovale were studied in 965 autopsy specimens of human hearts, which were from subjects who were evenly distributed by sex and age. Neither incidence nor size of the defect was significantly different between male and female subjects. The overall incidence was 27.3%, but it progressively declined with increasing age from 34.3% during the first three decades of life to 25.4% during the 4th through 8th decades and to 20.2% during the 9th and 10th decades. Among the 263 specimens that exhibited patency in our study, the foramen ovale ranged from 1 to 19 mm in maximal potential diameter (mean, 4.9 mm). In 98% of these cases, the foramen ovale was 1 to 10 mm in diameter. The size tended to increase with increasing age, from a mean of 3.4 mm in the first decade to 5.8 mm in the 10th decade of life.

Hagen, Philip T.↗

Evidence that Patent Foramen Ovale is not a Risk Factor for Cerebral Ischemia in the Elderly

Patent foramen ovale (PFO) may be a risk factor for ischemic stroke in young patients. The aim of this study was to assess the importance of PFO in subjects with a wider age range using patient-control methodology. Transesophageal contrast echocardiography and carotid imaging were performed in 220 consecutive patients with cerebral ischemia (mean age 66 +/- 13 years) and in 202 community-based control subjects (mean age 64 +/- 11 years). Of patients with stroke, 35 (16%) had PFO compared with 31 control subjects (15%) (p = 0.98). Analysis of PFO prevalence by age did not show a significant difference between patients and control subjects in the age groups <50 years (27% vs 11%p; = 0.33), 50 to 69 years (17% vs 15%; p = 0.78), and > or equal to 70 years (12% vs 17%; p = 0.43). However, the group aged 450 years was relatively small (26 cases, 19 controls). No significant difference in PFO prevalence was detected between patients with cryptogenic stroke (20%), noncryptogenic stroke (14%), and control subjects (15%). These results suggest that PFO is not a risk factor for cerebral ischemia in subjects aged >50 years, which would have major implications for the investigation and management of stroke patients in this age group. Longitudinal studies are now required to assess the incidence of stroke in symptom free patients with PFO.

Jones, Elizabeth F.↗

Transesophageal Echocardiography and Contrast-TCD in the Detection of a Patent Foramen Ovale: Experience with 111 Patients

Patent foramen ovale (PFO) is increasingly recognized in association with cryptogenic stroke. Using transesophageal echocardiography (TEE) and transcranial Doppler sonography with ultrasonic contrast medium contrast-(TCD), we evaluated the frequency of a PFO as the fundamental condition of paradoxical embolism in 111 patients after cerebral ischemia. There was a right-left shunt in 50 patients (45%) with TEE. In 31 of 40 patients with stroke of unknown etiology, a PFO was the only detectable finding associated with cerebral ischemia. Using TEE as he "gold standard," the sensitivity of contrast-TCD was 91.3%, specificity 93.8%, and the overall accuracy 92.8%. contrast-TCD failed to detect a right-left shunt in four patients, but there were four other patients with negative TEE and positive contrast-TCD. We conclude that contrast-TCD is a highly sensitive method for detecting a right-left shunt. Its advantages are low cost, its ability to detect single contrast-medium embolism, and control of the Valsalva maneuver by observing the decrease of cerebral blood flow. Evidence of PFO in cryptogenic stroke should prompt a search for a subclinical venous thrombosis as the embolic source.

Klotzsch, Christof↗

Combining Information on Multiple Detection Techniques to Estimate the Effect of Patent Foramen Ovale on Susceptibility to Decompression Illness

The assembly and the maintenance of the International Space Station is expected to require hundreds of extravehicular excursions (EVA's) in the next 10 years. During an EVA, in order to allow movement and bending of limbs, spacesuit pressures are reduced to about 4.3 psi. as compared with about 14.7 psi. for normal atmospheric pressure at sea level. However, the exposure of astronauts to reduced pressures in spacesuits, is conducive to fonnation and growth of gas bubbles within venous blood or tissues, which could cause decompression illness (DCI), a pathology best known to occur among deep-sea divers when they return to the surface. To reduce the risk of DCI, astronauts adjust to the reduced pressure in stages for a prolonged time known as a "pre-breathe" period prior to their extravehicular activity. Despite the use of pre-breathe protocols, an increased risk of DCI can arise for about 25% of humans who have a small hole, known as a patent foramen ovale (PFO), between two chambers of the heart. The atrial septum's fossa oval is, an embryological remnant of a flap between the septae primum and secundum allows fetal right atrial blood to pass into the left atrium, and usually closes after birth (Hagen, et al,. 1984). If fusion does not occur, a valve-like opening, the foramen ovale persists between the two atria. It has been suggested that astronauts with PFO's might be at greater risk of stroke or other serious neurological DCI because bubbles from a venous site may traverse a PFO, travel to the aorta and then enter the cerebral circulatory system causing a stroke (Figure 1). Astronauts are not now screened for PFO's, however consideration is being given to doing so. Here, we study three main methods abbreviated here as "ITE", "TCD" and "TEE", for detecting PFO's in living subjects. All involve the introduction of bubbles into a vein, immediately after which a sensory probe attempts to detect the bubbles in systemic circulation. Presence of the injected bubbles in the systemic circulation is indicative of a PFO. More detailed descriptions are given after the explanation of PFO's under Figure I. Even if a true PFO affects the risk of DCI, there remains a question of how effective screening would be if the detection method has errors of omission and/or commission. Of the three methods studied here, TEE is the "gold standard", matching autopsy results with near-perfect sensitivity and specificity (Schneider, et al. , 1996). However TEE is also the most difficult method to implement, requiring an internal esophagal probe, and is therefore not widely used. Currently, the easiest to use and most common PFO detection method is TTE, which uses an external chest probe. This method has a specificity of near 100%, but suffers from a low sensitivity rate (about 30%). More recently, TCD has been developed, which uses ultrasound probes to detect the presence of bubbles in cerebral arteries. Studies indicate that TCD is quite effective, having a sensitivity of about 91% and a specificity of about 93% (Droste, et al., 1999) when applied correctly, however implementation is difficult and requires considerable training.

Feiveson, Alan H.↗

WEC-Sim Modeling of Laminar Scientific's Patented Seesaw Wave Energy Converter: Preprint

Laminar Scientific's patented seesaw wave energy converter was modeled in WEC-Sim to predict performance. The device operates by utilizing ocean surface waves to rotate a truss in pitch about a pivot. The pivot is located at the top of two pylons, which are embedded in the seafloor. The seesaw has a float on either end, and the buoyancy forces from each float cause the system to rise or fall with passing waves. Device performance relies upon seesaw length and ocean wavelength creating an antiphase effect. The seesaw truss has an adjustable length intended to achieve this effect. The operation method enforces a narrow band of wavelengths which induce the largest rotational motion from the device. The hydrodynamic analysis of the device was performed using Capytaine, and the results confirmed that the device operates best in a narrow frequency band. Four float-to-float spacing cases and three pylon radii were examined. The hydrodynamic results indicate a match between the model and the physical expectations for the device, and that varying the pylon radii by 0.1-m increments for three instances creates minimal changes in hydrodynamic properties. Power matrices for three float spacing cases of the device were simulated with Joint North Sea Wave Project spectra waves and optimal power take-off damping in WEC-Sim. The maximum average power production for the 15-m spacing case was 14.1 kW with a 5.0-s peak wave period and 4-m significant wave heights. Plots of capture-width ratios indicated that the device performance was linear and confirmed that the device is optimal in a narrow frequency band. The maximum percentage of the available wave power produced by the 15-m device was approximately 16%. Simulations of the device in regular waves were used to produce plots of average power compared to a ratio of float spacing to wavelength. These plots indicate that the power production is maximized at a ratio of 0.5, and further confirm that the device has a narrow frequency response. The device was simulated at an example field location, where the device produced an annual average power rating of 1.6 kW given an average omnidirectional wave climate of 10.3 kW m-1 and an optimal, linearized power take-off model. While the maximum predicted device performance is reliant upon a narrow band of wave frequencies, the conducted analysis provides an opportunity to improve device design prior to prototyping and testing. Modifying the design to respond to a broader frequency range would improve device performance.

numerical modeling↗