Abstract NS 3: Severe Right To Left Shunt Through Pfo In Stroke And Tia Patients Predicted By Intraatrial Septum Morphology
Background: A patent foramen ovale (PFO) is more common in patients with cryptogenic stroke. The clinical implications of PFO morphology are still not well defined. Until ongoing randomized trials are completed, clinical decisions on performing PFO closure are often based on the extent of right to left shunt and PFO morphology along with clinical symptomatology and imaging data. Quantitative analysis by transesophageal echocardiography (TEE) is helpful in characterizing PFO morphology. The aim of this study was to determine whether there are certain characteristic on TEE, which correlate with PFOs shunt severity defined on trans cranial Doppler (TCD) in patients following stroke or transient ischemic attack.
Methods: We identified all patients who underwent both TCD and TEE in our medical center.For TCD we used the following classification: 1-10 bubbles- small shunt; 11-20 bubbles - moderate sunt; 21 or more (“curtain effect”) and shunt at rest- high-grade shunt. TEE films of the patients were viewed blinded to the TCD results and the anatomical characteristics of the ventricles, atria, atrial septum and tricuspidal valve for each patient were evaluated and recored.
Results: 101 patients fulfilled the criteria. In the univariate analysis the variables correlating with severe shunt were: right-to-Left bulging of the intra-atrial septum of more than 6 mm, tunnel length less than 9 mm, tunnel width more than 3 mm, smoking status and younger age. In the multivariate analysis only two variables retained independent association with severe shunt: right-to-left bulging of the intra-atrial septum of more than 6 mm and younger age.
Conclusion: In young patients who experience stroke or TIA, right to left interatrial bulging of more than 6 mm on TEE is a sensitive predictor of large PFO shunt and may increase stroke risk.
- © 2012 by American Heart Association, Inc.