Aim: The transcatheter closure of patent foramen ovale (PFO) is frequently performed in patients with cryptogenic stroke (CS), however echocardiograpic determinants of PFO associated with stroke is unknown. In this study, our aim was to evaluate the echocardiographic characteristics of PFO in association with CS and to identify high-risk patient population.
Methods: 116 consecutive patients diagnosed with PFO were enrolled into the study. Patients were categorized into 2 groups: patients suffered CS (CS group) (n=54) and no CS (control group) (n=62). Structural characteristics of PFO were examined by using transesophageal echocardiography (TEE) and contrast transesophageal echocardiography (c-TEE). Clinical, demographic characteristics of patients and structural differences of PFO between groups were then compared.
Results: Patients who suffered CS were older than patients in the control group. Both the height and length of the PFO during Valsalva maneuver were greater in CS group than in the control group. The incidence of low-angle PFO (angle between IVC and PFO ≤ 10°) and atrial septal aneurysm (ASA) was higher in the CS group than in the control group. During valsalva maneuver right-to-left shunt (RLS) ≥ grade II was significantly higher in the CS group compared to the control group. There was no significant difference between the two groups regarding RLS grades at rest. After multivariable analysis PFO length ≥ 10mm during Valsalva, low-angle PFO, presence of ASA and ≥ grade II RLS during Valsalva were found as independent predictors of CS.
Conclusions: Our study suggested that structural characteristics of PFO determined with TEE and c-TEE may help to identify patients at high-risk for CS.
Key words: Patent Formane Ovale, Cryptogenic Stroke, Echocardiography
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