Am J Cardiovasc Dis 2012;2(1):xxx-xxx
Perspective Article
Patent Foramen Ovale as a preferential mechanism for increasing the
likelihood of brain tumor metastasis
Gianluca Rigatelli, Andrea Rossi , Fabio Dell’Avvocata, Paolo Cardaioli
Adult Congenital Heart Disease Management Program, Cardiovascular Diagnosis and Endoluminal Interventions Unit,
Rovigo General Hospital, Rovigo, Italy; Department of Cardiology, Verona University School of Medicine and Surgery,
Verona, Italy
Received October 28, 2011; accepted December 6, 2011; Epub January 1, 2011; published January 15, 2011
Abstract: Metastases are the most common tumors of the central nervous system which may lie dormant behind the brain
blood- barrier sheltering from chemiotherapeutic drugs, and whose presence usually indicates a poor prognosis.
Development of brain metastases includes the intravasation of the cancer cells through the tumor blood vessels, their
circulation within the venous system, passing through the pulmonary filter thus reaching the systemic circulation. Patent
foramen ovale (PFO) is a natural communication between the right and left atrium with a prevalence of about 25% in the
general population. It may predispose to a right-to-left shunt by-passing the pulmonary filter. Recent literature suggests
that the presence of a permanent shunt, large shunt , atrial septal aneurysm and/or venous valve remnants, all increase
the risk of paradoxical embolism in PFO patients. The hypothesis that cancer cells may reach the brain circulation through
a significant PFO, might open up new fields in brain metastases pathophysiology and prevention. (AJCD1110001).
Keywords: Paradoxical embolism, cancer, metastasis, patent foramen ovale
Full Text PDF
Address all correspondence to:
Gianluca Rigatelli, MD, PhD
Adult Congenital Heart Disease Interventions
Cardiovascular Diagnosis and Endoluminal Interventions
Rovigo General Hospital
Viale Tre Martiri, 45100, Rovigo, Italy
Fax: +390425394513
Email: jackyheart71@yahoo.it
Perspective Article
Patent Foramen Ovale as a preferential mechanism for increasing the
likelihood of brain tumor metastasis
Gianluca Rigatelli, Andrea Rossi , Fabio Dell’Avvocata, Paolo Cardaioli
Adult Congenital Heart Disease Management Program, Cardiovascular Diagnosis and Endoluminal Interventions Unit,
Rovigo General Hospital, Rovigo, Italy; Department of Cardiology, Verona University School of Medicine and Surgery,
Verona, Italy
Received October 28, 2011; accepted December 6, 2011; Epub January 1, 2011; published January 15, 2011
Abstract: Metastases are the most common tumors of the central nervous system which may lie dormant behind the brain
blood- barrier sheltering from chemiotherapeutic drugs, and whose presence usually indicates a poor prognosis.
Development of brain metastases includes the intravasation of the cancer cells through the tumor blood vessels, their
circulation within the venous system, passing through the pulmonary filter thus reaching the systemic circulation. Patent
foramen ovale (PFO) is a natural communication between the right and left atrium with a prevalence of about 25% in the
general population. It may predispose to a right-to-left shunt by-passing the pulmonary filter. Recent literature suggests
that the presence of a permanent shunt, large shunt , atrial septal aneurysm and/or venous valve remnants, all increase
the risk of paradoxical embolism in PFO patients. The hypothesis that cancer cells may reach the brain circulation through
a significant PFO, might open up new fields in brain metastases pathophysiology and prevention. (AJCD1110001).
Keywords: Paradoxical embolism, cancer, metastasis, patent foramen ovale
Full Text PDF
Address all correspondence to:
Gianluca Rigatelli, MD, PhD
Adult Congenital Heart Disease Interventions
Cardiovascular Diagnosis and Endoluminal Interventions
Rovigo General Hospital
Viale Tre Martiri, 45100, Rovigo, Italy
Fax: +390425394513
Email: jackyheart71@yahoo.it
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