Patent Cardiac Foramen Ovale: Stroke Risk and Closure
Authors: J. P. Mohr, Shunichi Homma
Journal: Annals of Internal Medicine (2003)

Editorials4 November 2003Patent Cardiac Foramen Ovale: Stroke Risk and ClosureJ. P. Mohr, MD and Shunichi Homma, MDJ. P. Mohr, MDFrom College of Physicians and Surgeons of Columbia University; New York, NY 10032. and Shunichi Homma, MDFrom College of Physicians and Surgeons of Columbia University; New York, NY 10032.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-139-9-200311040-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail With increasingly sophisticated detection technology, patent cardiac foramen ovale has emerged from the arcane shadows of clinicopathologic conferences, where its diagnosis as a cause of embolic stroke was a challenge to the discussants (1). Given the common difficulties in finding a cause for ischemic stroke (2), demonstration of patent foramen ovale seems an acceptable explanation to most clinicians (3). No longer rarely diagnosed, patent foramen ovale is being increasingly documented by transesophageal echocardiography (TEE). The condition is best demonstrated by passage of microbubbles through the patent foramen ovale after intravenous injection of agitated saline. These same microbubbles, which spread widely ...References1. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 20-1968. N Engl J Med. 1968;278:1109-18. [PMID: 5646232] MedlineGoogle Scholar2. Sacco RL, Ellenberg JH, Mohr JP, Tatemichi TK, Hier DB, Price TR, . Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Ann Neurol. 1989;25:382-90. [PMID: 2712533] CrossrefMedlineGoogle Scholar3. Lechat P, Mas JL, Lascault G, Loron P, Theard M, Klimczac M, . Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318:1148-52. [PMID: 3362165] CrossrefMedlineGoogle Scholar4. Jauss M, Kaps M, Keberle M, Haberbosch W, Dorndorf W. 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[PMID: 8628471] CrossrefMedlineGoogle Scholar9. Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, . Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med. 2001;345:1740-6. [PMID: 11742048] CrossrefMedlineGoogle Scholar10. Khairy P, O'Donnell CP, Landzberg MJ. Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli. A systematic review. Ann Intern Med. 2003;139:753-60. LinkGoogle Scholar11. Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med. 1992;117:461-5. [PMID: 1503349] LinkGoogle Scholar12. Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. PFO in Cryptogenic Stroke Study (PICSS) Investigators. Circulation. 2002;105:2625-31. [PMID: 12045168] CrossrefMedlineGoogle Scholar13. Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, . A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001;345:1444-51. [PMID: 11794192] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From College of Physicians and Surgeons of Columbia University; New York, NY 10032.Disclosures: None disclosed.Corresponding Author: J.P. Mohr, MD, Neurological Institute, College of Physicians and Surgeons of Columbia University, 710 West 168th Street, New York, NY 10032; e-mail, [email protected]edu.Current Author Addresses: Dr. Mohr: Neurological Institute, College of Physicians and Surgeons of Columbia University, 710 West 168th Street, New York, NY 10032.Dr. Homma: Cardiology Division, College of Physicians and Surgeons of Columbia University, 710 West 168th Street, New York, NY 10032. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTranscatheter Closure versus Medical Therapy of Patent Foramen Ovale and Presumed Paradoxical Thromboemboli Paul Khairy , Clare P. O'Donnell , and Michael J. Landzberg Metrics Cited ByCardiac DiseasesLow cerebrovascular event rate in subjects with patent foramen ovale and different clinical presentationsCongenital Heart DiseaseCardiac DiseasesResponse to Letter by Altieri et alPatent Foramen Ovale and Cryptogenic Stroke: To Close or Not to Close? Closure: What Else!Overview of the 2007 Food and Drug Administration Circulatory System Devices Panel Meeting on Patent Foramen Ovale Closure DevicesAlmost Perfect Concordance Between Simultaneous Transcranial Doppler and Transesophageal Echocardiography in the Quantification of Right-to-Left ShuntsPerinatal and neonatal ischaemic stroke: A reviewPatent Foramen Ovale and StrokeTranscatheter closure of atrial septal defectsCongenital Heart Disease 4 November 2003Volume 139, Issue 9Page: 787-788KeywordsArteriesAspirinBrainClinical trialsInfarctionIschemic strokeMedical risk factorsStrokeSurgeonsThrombosis ePublished: 4 November 2003 Issue Published: 4 November 2003 CopyrightCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...