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The balloon cryoablation (CA) procedure is an established method for the permanent treatment of atrial fibrillation (AF). Like other surgical interventions, it is associated with the potential development of early and late complications, including neurological ones such as migraine. We report a case of migraine headaches after the CA procedure. 25-year-old man with paroxysmal AF, without comorbidities, underwent balloon CA. On the second day after the procedure, the patient developed visual symptoms typical of migraine aura. After 30 minutes, these symptoms disappeared and appeared classic migraine headache attack. Similar episodes occurred over the following days. A focal central nervous system lesion was ruled out and a diagnosis of migraine with aura was made. The patient received a typical migraine attack treatment. The attacks ceased within two weeks. 3 months later during the follow-up visit at the neurology clinic no abnormalities were detected. We decided to check if the migraine is a rare complication of AF ablation surgery. Many studies do not include migraine headaches at all in the neurological complications of ablation. However, based on some studies, it may seem that the incidence of migraine as a complication of ablation is underestimated.

Resumen: La endocarditis infecciosa es una enfermedad mortal, que a pesar de las mejoras en su manejo sigue estando asociada a gran mortalidad y complicaciones graves. Es una complicación excepcional del cierre percutáneo de foramen oval permeable. Se presenta un caso clínico de un hombre de 52 años intervenido de cierre percutáneo de foramen oval permeable detectado en el estudio etiológico de un ictus. Tres años después, el paciente presentó un cuadro clínico compatible con endocarditis, encontrándose una gran vegetación endocardítica anclada a la vertiente auricular izquierda del dispositivo de cierre de foramen oval permeable. Los hemocultivos fueron positivos para Staphylococcus aureus. Se realizó cirugía con resección del dispositivo. La evolución postoperatoria fue satisfactoria. Abstract: Infective endocarditis is a fatal disease that, despite improvements in its management, is still associated with a high rate of mortality and complications. It is an exceptional complication of percutaneous patent foramen ovale closure. A case report is presented of a 52-year-old man who underwent percutaneous closure of a percutaneous patent foramen ovale diagnosed during the aetiological study of a stroke. Three years after the procedure, the patient presented with symptoms of endocarditis. A large endocarditic growth was found to be anchored to the left atrial surface of the percutaneous patent foramen ovale closure device. Blood cultures were positive for Staphylococcus aureus. Surgery was performed and the device was removed. Postoperative recovery was satisfactory.

The association of cerebral ischemic attack with patent foramen ovale has not been extensively studied, and frequently the site of origin of embolism is not detected despite routine studies. We present the case of a young patient with ischemic stroke and permeable oval foramen in the context of May Thurner syndrome. The May Thurner syndrome is an entity scarcely studied in the medical literature and it has also been infrequently related to ischemic vascular cerebral accident, but in patients with permeable oval foramen without evidence of the emboligen source, it is interesting to rule it out as a cause of paradoxical embolism.

En: Platypnea orthodeoxia (PO) syndrome is characterized by dyspnea and orthostatic hypoxemia. Various cardiac and noncardiac conditions responsible for the pathophysiological mechanisms involved in the syndrome are found during differential diagnosis. We searched the records of Hospital Universitario Miguel Servet in Saragossa for confirmed cases of PO syndrome diagnosed between January 2002 and June 2014 and found 4 cases. Three were secondary to rightto- left shunt by way of a patent foramen ovale. The fourth was secondary to an intrapulmonary vascular shunt in the context of hepatopulmonary syndrome. A total of 129 titles on PO syndrome were indexed in MEDLINE between 1979 and April 2013; 77% were published in the last 10 years. PO syndrome is under diagnosed. The evident increase in incidence in recent years is probably attributable to better diagnostic techniques.

Although patent foramen ovale is a relatively common disease, the presence of paradoxical embolism is a rare clinical condition, representing less than 2% of arterial ischemias. We report the case of a 55-year-old male diagnosed with massive pulmonary embolism and paradoxical embolism in the right arm, secondary to patent foramen ovale. We also highlight some uncertainties in the diagnosis and treatment of patients with paradoxical embolism., (Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.)

Introduction: Temporal lobe epilepsy (TLE) is commonly associated with the process of synchronisation during the interictal stage, which show up as 'spikes' on neurophysiological recordings, and also with hypersynchronic activity during clinical seizures. Nevertheless, desynchronisation also seems to play an important role in the epileptogenic process, favouring the onset of seizures., Aims: The aim of this work is to show how the latest complex network analysis techniques applied to the recordings from the foramen ovale electrodes provide valuable new information about the dynamics of mesial activity in TLE. The study also seeks to show that desynchronisation of the mesial activity plays an important role in TLE., Patients and Methods: A cluster technique was used to analyse the recordings of six patients with TLE during the interictal stage and two seizures during the ictal period. RESULTS. Electrical activity on the ipsilateral side behaves in a less synchronic manner than that of the contralateral side. There is clearly a greater tendency in the mesial zone of the epileptic side to arrange itself in isolated groups of synchronic activity than on the contralateral side, which is organised in large groups of synchronised activity., Conclusions: Analysis of the neurophysiological recordings, especially from the foramen ovale electrodes, by cluster and network analysis provides novel information that is not accessible by classical spike analysis. The greater degree of desynchronisation on the ipsilateral side would favour the appearance and origin of the seizures on that side.

Objective: The applications of endoscopic ultrasonography have diversified over recent years. The possibility of reaching cardiac territory has been successfully explored in experimental models, opening up a new field of possibilities for diagnostic and therapeutic interventions that were unthinkable until very recently. The aims set out in this study are to evaluate cardiac anatomy, its approach, the safety of the experimental procedure and the resulting morphological and histological changes after the procedure., Material and Methods: The study has been performed on two adult pigs. They have undergone different surgical approaches to the cardiac cavities and descending thoracic aorta with excellent results., Results: Different cardiac structures have been identified and operated upon (right auricle, left auricle, left ventricle, cardiac valves), as well as major vessels. The use of contrast, both intracavitary and from a peripheral vein, enabled us to verify the anatomical spaces studied. During the procedures we monitored for arrhythmias, hemodynamic behavior, possibility of infection by obtaining sample hemocultures before and after procedures, and response to punctures., Conclusions: The present study has enabled us to evaluate access to the heart from the esophageal lumen using endoscopic ultrasonography, with results that are very similar to those described in the current bibliography. However, we offer two novelties: puncture of the right auricle through the interauricular partition and puncture of the descending thoracic aorta, both performed with ease and apparent safety.