#спасибодоктор COVID19
Do you know if you have an oval window or not? Take the check-up program and find out!
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Patient Sh, 29 years old

The final diagnosis:
An open oval window. Acute violation of cerebral circulation in the right hemisphere of the ischemic type in the basin of the right middle cerebral artery from 07.03.2018. Operation of endovascular closure of an open oval window with implantation of a FigullaFlex II ASD 23/25 mm occluder from 16.05.2018.

The history of life

  • During the whole period I felt satisfactory, I didn’t go to the doctors.
  • Heredity is not burdened
  • He denies any bad habits
  • Related diseases: Autoimmune thyroiditis
  • Past illnesses: acute respiratory viral infections 2-3 times a year
  • Gynecological history: 2 pregnancies, 2 births, taking oral contraceptives for 3 months

Anamnesis of the disease

  • 07.03.2018 for the first time I noticed the following complaints: Weakness, numbness of the upper left limb, which was self-relieved within 10 minutes
  • 08.03.2018-14.03.18-constant repetition of episodes of the above-described complaints, in connection with which she was hospitalized in the state hospital No. 81
  • According to MRI data: focal changes in the right hemisphere. The diagnosis was made: onsc of ischemic type in the basin of the right middle cerebral artery from 07.03.2018
  • According to ECHO KG: an open oval window with the presence of a left-right shunt
  • 07.04.2018 hematologist consultation: low risk of thrombophilia

Interpretation of risk on the RoPE scale

ПредикторБаллПациент

Артериальная гипертензия (отсутствие)

+1

1

Сахарный диабет (отсутствие)

+1

1

Отсутствие ОНМК или ТИА в анамнезе

+1

1

Некурящий пациент

+1

1

Наличие коркового инсульта

+1

1

Возраст (лет)

18-29

+5

5

30-39

+4

40-49

+3

50-59

+2

60-69

+1

≥70

0

Максимальный балл

10

10

Interpretation of risk on the RoPE scale

Балл RoPEВероятность взаимосвязи ОНМК  с ООО (95% доверительный  интервал)Ожидаемая вероятность  рецидива ОНМК/ТИА в  течение 2-х лет

0-3

0% (0–4)

20% (12–28)

4

38% (25–48)

12% (6–18)

5

34% (21–45)

7% (3–11)

6

62% (54–68)

8% (4–12)

7

72% (66–76)

6% (2–10)

8

84% (79–87)

6% (2–10)

9-10

88% (83–91)

2% (0–4)

At receipt

  • The condition is satisfactory
  • General and biochemical blood analysis, General urine analysis-without features
  • Smad: indicators of the daily blood pressure profile within normal values
  • USDG of brachiocephalic arteries: 25% stenosis at the mouth of the right subclavian artery
  • Consultation with an endocrinologist: it is possible to perform an intervention against the background of taking tyrosol
  • Consultation of a neurologist: Taking into account the ischemic type of onsc against the background of LLC, it is recommended to conduct endovascular closure of LLC to prevent repeated onsc
  • Therapy: acetylsalicylic acid, enteric form 75 mg/day, clopidogrel 75 mg/day, tyrosol 30 mg/day

ECHO KG

  • the heart cavities are not enlarged, the walls are not thickened, and the contractility of the myocardium is satisfactory. No areas of violation of local contractility were found. Diastolic function of the LV myocardium is not impaired. There are no signs of pulmonary hypertension. Hemodynamically insignificant valvular regurgitations
  • The MPP swells out into the right atrium cavity up to 0.5 mm, and a bypass blood flow from left to right cannot be excluded.
Open oval window measuring 2 mm.
MPP aneurysm 2.1×0.7 cm.
Resting blood discharge from left to right

Justification for endovascular closure of an LLC

  • It is characterized by ischemic type
  • LLC in combination with aneurysm MPP
  • LLC size 2 mm
  • Whether there is a left-to-right reset at rest

Conducting a conductor through the heart into the left pulmonary vein

The disclosure of the device

Checking the stability and disconnecting the device

Position control

Type of device after implantation

Control bubble sample

ECM KG after 4 months after installing the occluder