Characteristics of patent foramen ovale associated with cryptogenic stroke. A biplane transesophageal echocardiographic study.

Abstract

Background and Purpose Patent foramen ovale is associated with ischemic stroke in patients without a clearly identifiable etiology for stroke (cryptogenic stroke). Paradoxical embolization is thought to be a potential mechanism. However, patent foramen ovale is also found in patients with known cause of stroke. Therefore, using contrast transesophageal echocardiography, we characterized the patent foramen ovale in cryptogenic stroke patients to assess morphological factors that may contribute to paradoxical embolization.Methods Contrast transesophageal echocardiographic studies of 74 consecutive patients referred for ischemic stroke were reviewed. Twenty-three patients with patent foramen ovale were identified. These patients were classified as having strokes of determined origin or cryptogenic strokes according to criteria developed for the Stroke Data Bank of the National Institute of Neurological Disorders and Stroke. Separation of septum primum from secundum and the number of microbubbles appearing in left atrium were then quantitated. These

Effect of Medical Treatment in Stroke Patients With Patent Foramen Ovale

“…28 The size and the degree of shunt appear to be important in determining the significance of PFO. [15][16][17][18] In this study, with a large number of prospectively studied patients, we also confirm that larger PFOs are associated with cryptogenic stroke. We demonstrate that when the stroke patients are treated medically, the rate of recurrent stroke or death is similar between patients with and without PFO.…”

“…24,25 PFO size was determined by use of a caliper on a video frame demonstrating the maximum separation of the septum primum from the septum secundum. 15, 17 The number of microbubbles was counted from a video frame demonstrating the maximum number on a video frame within 3 cardiac cycles from the opacification of the right atrium. 15,17,24,25 PFOs with Ն2 mm separation of the septum secundum and primum or with Ն10 microbubbles appearing in the left atrium were classified as large, and all other PFOs as small.…”

“…15, 17 The number of microbubbles was counted from a video frame demonstrating the maximum number on a video frame within 3 cardiac cycles from the opacification of the right atrium. 15,17,24,25 PFOs with Ն2 mm separation of the septum secundum and primum or with Ն10 microbubbles appearing in the left atrium were classified as large, and all other PFOs as small. ASA was defined as a movement of the atrial septum into the left or right atrium Ն10 mm from its midline position.…”

Contemporary Management of Patent Foramen Ovale

“…Homma et al 25 identified other risk factors: (1) the presence of a Eustachian valve directed toward the PFO ( Figure 3); (2) the gaping diameter of the PFO; and (3) the number of micro-bubbles present in the left atrium during the first seconds after release of a Valsalva maneuver during a bubble test.…”

Surgical prophylaxis secundary to cryptogenic stroke or transient ischemic attack in patients with patent foramen ovale

“…This situation threatened these young adults as was demonstrated at the start of the 1990s in retrospective studies by COMESS et al [8], STONE et al [9] (8.4%), MAS & ZUBER [10] (3.4%) and prospective studies by BOGOUSSLAVSKY [11] (3.8%). These ratifications led several authors (DI TULLIO et al [12], CABANES et al [13] and HOMMA et al [14] to define to what extent the anatomical structures of the interatrial septum could be implicated in embolic events. This aspect is of fundamental importance for the stratification of recurrence risk of strokes or TIA until the present time.…”