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Case Reports
. 2023 Feb;37(2):261-265.
doi: 10.1053/j.jvca.2022.10.014. Epub 2022 Oct 19.

NobleStitch Patent Foramen Ovales Closure for Recurrent Strokes in a Patient with COVID-19 on Extracorporeal Membrane Oxygenation

Perry A Stout  1 , Nika Samadzadeh Tabrizi  2 , Matt Tribble  3 , Tanya Richvalsky  3 , Cindy Youn  3 , Brion Winston Md  4 , Alexander D Shapeton  5 , Sridhar R Musuku  6
Affiliations
Case Reports

NobleStitch Patent Foramen Ovales Closure for Recurrent Strokes in a Patient with COVID-19 on Extracorporeal Membrane Oxygenation

Perry A Stout et al. J Cardiothorac Vasc Anesth. 2023 Feb.
No abstract available

Keywords: COVID-19; NobleStitch; cryptogenic stroke; echocardiography; intracardiac shunt; patent foramen ovale.

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Figures

Fig 1
Fig 1
The NobleStitch delivery system consisting of 3 catheters: the NobleStitch S for capturing of the septum secundum, the NobleStitch P for capturing of the septum primum, and the KwiKnot catheter for knot application and trimming of excess suture material.
Fig 2
Fig 2
Head computed tomography demonstrating a wedge-shaped area of low attenuation within the inferomedial aspect of the left cerebellar hemisphere with loss of gray-white differentiation in the axial (Inset A) and sagittal views (Inset B), consistent with subacute infarction.
Fig 3
Fig 3
Transthoracic echocardiography bubble study demonstrating the presence of saline contrast (bubbles) in the left ventricle, diagnostic of a right-to-left intracardiac shunt through a patent foramen ovale.
Fig 4
Fig 4
Transesophageal echocardiography demonstrating V-sign, a V-shaped indent on the septum primum, which reflects tension due to the NobleStitch KwiKnot.
Fig 5
Fig 5
Schematic representation of the NobleStitch in closure of patent foramen ovale, demonstrating suture through the septum secundum, suture through the septum primum, suture pulling just prior to KwiKnot deployment, and suture tying using the KwiKnot.
See this image and copyright information in PMC

References

    1. Kass M, Arya VK, Shah AH. COVID-19–positive patient and hypoxemia: Are lungs always to be blamed? JACC Cardiovasc Interv. 2021;14:e101–e102. - PMC - PubMed
    1. Vanhomwegen C, Taton O, Selvais N, et al. Patent foramen ovale revealed by COVID-19 pneumonia. BMC Pulm Med. 2021;21:126. - PMC - PubMed
    1. Rigatelli G, Zuin M. Managing patent foramen ovale in COVID-19 patients during and after viral infection: An unresolved matter. J Cardiovasc Med (Hagerstown) 2021;22:259–260. - PubMed
    1. Rajendram R, Kharal GA, Mahmood N, et al. Systemic thromboemboli in patients with COVID-19 may result from paradoxical embolization. Thromb Res. 2020;196:206–208. - PMC - PubMed
    1. Musuku SR, Srikanthan A, Cherukupalli D, et al. NobleStitch EL PFO closure guided by transesophageal echocardiography. J Cardiothorac Vasc Anesth. 2022;36:549–552. - PubMed

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