Chiari network and paradoxical embolism. Response.

We have read the comments of Martı́nez-Quintana et al ncerning the article entitled ‘‘Giant Chiari Network, Foramen ale, and Paradoxical Embolism’’ with interest. As Martı́nez-Quintana et al argue, paradoxical embolism should ainly be taken into account in young patients in whom there is no her cause to explain the occurrence of the stroke. Although the tient in the reported case exhibited other risk factors, the stroke had experienced years before the intervention could not be tributed to them with absolute certainty. Moreover, there was no idence of arrhythmias at the time the patient had the stroke and, spite the fact that there was no sign of peripheral venous disease, agulation disorders, or atrial septal aneurysm, these conditions e not considered essential for the existence of a paradoxical bolism, even in young patients. Patent foramen ovale has been dependently related to paradoxical embolism. Right-to-left shunt facilitates paradoxical embolism. In tients with cryptogenic stroke and patent foramen ovale, this unt is detected by resting transesophageal echocardiogram in 2% of the cases. However, it is found in 15.3% when the hocardiogram is associated with the Valsalva maneuver. Thus, e failure to detect the shunt in a patient at rest does not imply at it is not always present during the cardiac cycle. Although the Chiari network is found in 2% to 3% of the pulation and is associated with patent foramen ovale in 83% of e cases, the incidence of paradoxical embolism is lower than pected and, thus, has been reported to act as a protective filter ainst pulmonary embolisms. However, Chiari network is more quently detected on echocardiography performed in patients rmation of atrial thrombi. The Chiari network is generally a fine, flat, fenestrated structure t, in this case, the morphology observed, its intimate contact ith the patent foramen ovale, and its compact texture lead us to ink that it facilitated the formation of the thrombus and its ovement toward the patent foramen ovale.