Anatomical features of percutaneously closed patent foramen ovale in patients with cryptogenic stroke.

Abstract

Background: Patent foramen ovale (PFO) is increasingly recognized as a cause of stroke, with a prevalence of approximately 25% in the general population. Consequently, the likelihood of encountering a 'bystander PFO' in young patients who have experienced a stroke seems significant. To aid in identifying patients with a PFO-related cryptogenic stroke, an interdisciplinary Heart-Stroke Team (HST) has been established. This team evaluates patients who have suffered from stroke and were diagnosed with a PFO to assess its potential contribution. Understanding the anatomical features of PFOs associated with stroke is essential for decision-making. This study examines the PFO characteristics of all patients who underwent percutaneous PFO closure for cryptogenic stroke at two congenital heart disease institutions in the Netherlands.

Methods: Data on all patients who underwent PFO closure from 2016 to 2022 were collected. Anatomical characteristics were measured using transesophageal echocardiography and analyzed by two cardiologists.

Results: In total, 223 patients underwent PFO closure. The mean age was 42.8 ± 10.7 years, with 115 (51.6%) being male. Approximately 80% of all patients had at least one risk-enhancing PFO feature (moderate to severe shunt and/or atrial septal aneurysm of > 10 mm).

Conclusion: Although all patients accepted for percutaneous PFO closure were individually assessed by a dedicated HST, 20% had a PFO without risk-enhancing features but were still accepted for closure due to other reasons. This highlights the importance of careful individual assessment of young stroke patients with a PFO. Future studies are needed to identify the characteristics that contribute to stroke in these patients.