(Stroke. 2000;31:2407.)
© 2000 American Heart Association, Inc.
Original Contributions |
Morphological and Functional Characteristics of Patent Foramen Ovale and Their Embolic Implications
From the Departments of Clinical Medicine (S.D.C., D.C.), Cardiovascular and Respiratory Sciences (F.F.), and Neurological Sciences (M.F., M.R., A.A., E.M.Z., M.B., C.C., C.F.), "La Sapienza" University, Rome, Italy; and the New England Medical Center (N.G.P.), Tufts University, Boston, Mass.
Correspondence to Stefano De Castro, MD, Dipartimento di Medicina Clinica, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy. E-mail migliau{at}axcasp.caspur.it
Background and Purpose—Transesophageal echocardiography (TEE) has detected a high prevalence of patent foramen ovale (PFO) in stroke patients, but the clinical implications of the distinctive characteristics of this patency are still a matter of debate.
Methods—We studied 350 patients with acute ischemic stroke or transient ischemic attack (TIA) within 1 week of admission. Of these, 101 (29%) were identified by contrast TEE to have a PFO; 86 patients (25%) were cryptogenic stroke patients, and 163 were excluded because of the presence of a definite or possible arterial or clinical evidence of a source of emboli or small-vessel disease. Thirteen PFO subjects without a history of embolism were designated as the control group. All PFO and cryptogenic stroke patients were followed up by neurological visits.
Results—Compared with controls, PFO patients with acute stroke or TIA more frequently presented with a right-to-left shunt at rest and a higher membrane mobility (P<0.05). Patients with these characteristics were considered to be at high risk. During a median follow-up period of 31 months (range, 4 to 58 months), 8 PFO and 18 cryptogenic stroke patients experienced recurrent cerebrovascular events. The cumulative estimate of risk of cerebrovascular event recurrence at 3 years was 4.3% (95% confidence interval [CI], 0% to 10.2%) for "low-risk" PFO patients, 12.5% (95% CI, 0% to 26.1%) for "high-risk" PFO patients, and 16.3% (95% CI, 7.2% to 25.4%) for cryptogenic stroke patients (high-risk PFO versus low-risk PFO, P=0.05).
Conclusions—The association of right-to-left shunting at rest and high membrane mobility, as detected by contrast TEE, seems to identify PFO patients with cerebrovascular ischemic events who are at higher risk for recurrent brain embolism.
Key Words: cerebral ischemia • echocardiography • embolism • foramen ovale, patent
This article has been cited by other articles:
 |
|
 |
|
  E. E. Williamson, J. Kirsch, P. A. Araoz, W. B. Edmister, D. D. Borgeson, J. F. Glockner, and J. F. Breen ECG-Gated Cardiac CT Angiography Using 64-MDCT for Detection of Patent Foramen Ovale Am. J. Roentgenol., April 1, 2008; 190(4): 929 - 933. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Doufekias, A. Z. Segal, and J. R. Kizer Cardiogenic and aortogenic brain embolism. J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1049 - 1059. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sarkar, S. Ghosh, S. K. Ghosh, and A. Collier Role of transcranial Doppler ultrasonography in stroke Postgrad. Med. J., November 1, 2007; 83(985): 683 - 689. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Sievert, E. Fischer, C. Heinisch, N. Majunke, A. Roemer, and N. Wunderlich Transcatheter Closure of Patent Foramen Ovale Without an Implant: Initial Clinical Experience Circulation, October 9, 2007; 116(15): 1701 - 1706. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. I.I. Soliman, M. L. Geleijnse, F. J. Meijboom, A. Nemes, O. Kamp, P. Nihoyannopoulos, N. Masani, S. B. Feinstein, and F. J. Ten Cate The use of contrast echocardiography for the detection of cardiac shunts Eur J Echocardiogr, June 1, 2007; 8(3): s2 - s12. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Johansson, P. Eriksson, Y. Peker, J. Hedner, L. Rastam, and U. Lindblad The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea Eur. Respir. J., January 1, 2007; 29(1): 149 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. H. Bonati, A. Kessel-Schaefer, A. Z. Linka, P. Buser, S. G. Wetzel, E.-W. Radue, P. A. Lyrer, and S. T. Engelter Diffusion-Weighted Imaging in Stroke Attributable to Patent Foramen Ovale: Significance of Concomitant Atrial Septum Aneurysm Stroke, August 1, 2006; 37(8): 2030 - 2034. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Marini, M. Miniati, N. Ambrosino, B. Formichi, L. Tonelli, G. Di Ricco, C. Michelassi, S. Giusti, and I. Spadoni Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt. Eur. Respir. J., July 1, 2006; 28(1): 174 - 181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Circulation, March 14, 2006; 113(10): e409 - e449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, February 1, 2006; 37(2): 577 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Meier Patent Foramen Ovale, Guilty But Only as a Gang Member and for a Lesser Crime J. Am. Coll. Cardiol., January 17, 2006; 47(2): 446 - 448. [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Kizer and R. B. Devereux Clinical practice. Patent foramen ovale in young adults with unexplained stroke. N. Engl. J. Med., December 1, 2005; 353(22): 2361 - 2372. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Schwerzmann, K. Nedeltchev, F. Lagger, H. P. Mattle, S. Windecker, B. Meier, and C. Seiler Prevalence and size of directly detected patent foramen ovale in migraine with aura Neurology, November 8, 2005; 65(9): 1415 - 1418. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Homma and R. L. Sacco Patent Foramen Ovale and Stroke Circulation, August 16, 2005; 112(7): 1063 - 1072. [Full Text] [PDF]
|
|
|
|
 |
|
 B Meier Closure of patent foramen ovale: technique, pitfalls, complications, and follow up Heart, April 1, 2005; 91(4): 444 - 448. [Full Text] [PDF]
|
|
|
|
|
|
A. Wahl, U. Krumsdorf, B. Meier, H. Sievert, S. Ostermayer, K. Billinger, M. Schwerzmann, U. Becker, C. Seiler, M. Arnold, et al. Transcatheter treatment of atrial septal aneurysm associated with patent foramen ovale for prevention of recurrent paradoxical embolism in high-risk patients J. Am. Coll. Cardiol., February 1, 2005; 45(3): 377 - 380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G.P. Anzola, E. Morandi, F. Casilli, and E. Onorato Does Transcatheter Closure of Patent Foramen Ovale Really "Shut the Door?": A Prospective Study With Transcranial Doppler Stroke, September 1, 2004; 35(9): 2140 - 2144. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Wu, J. F. Malouf, J. A. Dearani, D. J. Hagler, G. S. Reeder, G. W. Petty, and B. K. Khandheria Patent Foramen Ovale in Cryptogenic Stroke: Current Understanding and Management Options Arch Intern Med, May 10, 2004; 164(9): 950 - 956. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Messe, I. E. Silverman, J. R. Kizer, S. Homma, C. Zahn, G. Gronseth, and S. E. Kasner Practice Parameter: Recurrent stroke with patent foramen ovale and atrial septal aneurysm: Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology, April 13, 2004; 62(7): 1042 - 1050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Devuyst, B. Piechowski-Jozwiak, T. Karapanayiotides, J.-W. Fitting, V. Kemeny, L. Hirt, L. A. Urbano, P. Arnold, G. van Melle, P.-A. Despland, et al. Controlled Contrast Transcranial Doppler and Arterial Blood Gas Analysis to Quantify Shunt Through Patent Foramen Ovale Stroke, April 1, 2004; 35(4): 859 - 863. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Schwerzmann, S Windecker, A Wahl, H Mehta, K Nedeltchev, H Mattle, C Seiler, and B Meier Percutaneous closure of patent foramen ovale: impact of device design on safety and efficacy Heart, February 1, 2004; 90(2): 186 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J Landzberg and P. Khairy Indications for the closure of patent foramen ovale Heart, February 1, 2004; 90(2): 219 - 224. [Full Text] [PDF]
|
|
|
|
|
|
J. W. Moore and D. S. Levi Transcatheter closure of atrial shunts: Focus on a lingering issue J. Am. Coll. Cardiol., January 21, 2004; 43(2): 310 - 312. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Khairy, C. P. O'Donnell, and M. J. Landzberg Transcatheter Closure versus Medical Therapy of Patent Foramen Ovale and Presumed Paradoxical Thromboemboli: A Systematic Review Ann Intern Med, November 4, 2003; 139(9): 753 - 760. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Rodriguez, S. Homma, R. L. Sacco, M. R. Di Tullio, R. R. Sciacca, and J.P. Mohr Race-Ethnic Differences in Patent Foramen Ovale, Atrial Septal Aneurysm, and Right Atrial Anatomy Among Ischemic Stroke Patients Stroke, September 1, 2003; 34(9): 2097 - 2102. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Meier and J. E. Lock Contemporary Management of Patent Foramen Ovale Circulation, January 7, 2003; 107(1): 5 - 9. [Full Text] [PDF]
|
|
|
|
 |
|
 W. K. Blersch, B. M. Draganski, S. R. Holmer, H. J. Koch, F. Schlachetzki, U. Bogdahn, and T. Holscher Transcranial Duplex Sonography in the Detection of Patent Foramen Ovale Radiology, December 1, 2002; 225(3): 693 - 699. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Lee, S.-I. Sohn, D.-K. Jung, Y.-W. Cho, J.-G. Lim, S.-D. Yi, S.-R. Lee, C.-H. Sohn, and R. W. Baloh Sudden Deafness and Anterior Inferior Cerebellar Artery Infarction Stroke, December 1, 2002; 33(12): 2807 - 2812. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A K Demetriades, K Nedeltchev, M Arnold, H Mattle, S Windecker, and A Wahl Patent foramen ovale, cerebrovascular risk, and complement J. Neurol. Neurosurg. Psychiatry, September 1, 2002; 73(3): 351 - 351. [Full Text] [PDF]
|
|
|
|
|
|
S. Homma, R. L. Sacco, M. R. Di Tullio, R. R. Sciacca, J.P. Mohr, and for the PFO in Cryptogenic Stroke Study (PICSS) In Effect of Medical Treatment in Stroke Patients With Patent Foramen Ovale: Patent Foramen Ovale in Cryptogenic Stroke Study Circulation, June 4, 2002; 105(22): 2625 - 2631. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Horowitz, R. Carrau, D. Crammond, and E. Kanal Risks of Tumor Embolization in the Presence of an Unrecognized Patent Foramen Ovale: Case Report AJNR Am. J. Neuroradiol., June 1, 2002; 23(6): 982 - 984. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Nedeltchev, M Arnold, A Wahl, M Sturzenegger, E E Vella, S Windecker, B Meier, and H P Mattle Outcome of patients with cryptogenic stroke and patent foramen ovale J. Neurol. Neurosurg. Psychiatry, March 1, 2002; 72(3): 347 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-L. Mas, C. Arquizan, C. Lamy, M. Zuber, L. Cabanes, G. Derumeaux, J. Coste, and the Patent Foramen Ovale and Atrial Septal Aneurys Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both N. Engl. J. Med., December 13, 2001; 345(24): 1740 - 1746. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Rachko, A. M. Safi, D. Yeshou, N. Pillai, L. Salciccioli, and R. A. Stein Cryptogenic Ischemic Stroke and Paradoxical Embolism: Should A Patent Foramen Ovale Be Closed?: Case Report and Literature Review Angiology, November 1, 2001; 52(11): 793 - 799. [Abstract] [PDF]
|
|