Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence
Authors: Preetham Kumar, Mohammad K. Mojadidi, Jonathan M. Tobis
Journal: Annals of Internal Medicine (2020)

Letters1 December 2020Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke RecurrencePreetham Kumar, MD, Mohammad K. Mojadidi, MD, and Jonathan M. Tobis, MDPreetham Kumar, MDUniversity of California, Los Angeles, Los Angeles, California (P.K., J.M.T.)Search for more papers by this author, Mohammad K. Mojadidi, MDVirginia Commonwealth University, Richmond, Virginia (M.K.M.)Search for more papers by this author, and Jonathan M. Tobis, MDUniversity of California, Los Angeles, Los Angeles, California (P.K., J.M.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1272 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Deng and colleagues (1) investigated the effect of residual right-to-left shunt (RLS) after patent foramen ovale (PFO) closure on the incidence of recurrent stroke or transient ischemic attack (TIA). They concluded that the presence of residual shunting was associated with an increase in cerebrovascular events. This observation is important, and we would like to emphasize a few points.The differential diagnosis for TIA includes other causes of transient neurologic deficits, such as migraine with aura (2). Both TIA and migraine with aura can present with similar symptoms that recede within 24 hours, and patients with both of ...References1. Deng W, Yin S, McMullin D, et al. Residual shunt after patent foramen ovale closure and long-term stroke recurrence. A prospective cohort study. Ann Intern Med. 2020;172:717-25. doi:10.7326/M19-3583 LinkGoogle Scholar2. Amarenco P. Transient ischemic attack. N Engl J Med. 2020;382:1933-41. [PMID: 32402163] doi:10.1056/NEJMcp1908837 CrossrefMedlineGoogle Scholar3. Gevorgyan Fleming R, Kumar P, West B, et al. Comparison of residual shunt rate and complications across 6 different closure devices for patent foramen ovale. Catheter Cardiovasc Interv. 2020;95:365-72. [PMID: 31654558] CrossrefMedlineGoogle Scholar4. Mojadidi MK, Winoker JS, Roberts SC, et al. Accuracy of conventional transthoracic echocardiography for the diagnosis of intracardiac right-to-left shunt: a meta-analysis of prospective studies. Echocardiography. 2014;31:1036-48. [PMID: 24689727] doi:10.1111/echo.12583 CrossrefMedlineGoogle Scholar5. Mojadidi MK, Gevorgyan R, Tobis JM. A comparison of methods to detect and quantitate PFO: TCD, TTE, ICE and TEE.. In: Amin Z, Tobis J, Sievert H, et al, eds. Patent Foramen Ovale. Springer; 2015:55-65. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of California, Los Angeles, Los Angeles, California (P.K., J.M.T.)Virginia Commonwealth University, Richmond, Virginia (M.K.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1272. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoResidual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence Wenjun Deng , Shanye Yin , David McMullin , Ignacio Inglessis-Azuaje , Sammy Elmariah , Judy Hung , Eng H. Lo , Igor F. Palacios , Ferdinando S. Buonanno , and MingMing Ning Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence Alexia Karagianni , Peter Eriksson , and Mikael Dellborg Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence Wenjun Deng , Shanye Yin , David McMullin , Ignacio Inglessis-Azuaje , Sammy Elmariah , Judy Hung , Eng H. Lo , Igor F. Palacios , Ferdinando S. Buonanno , and MingMing Ning Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence Gaurav Aggarwal , Saurabh Aggarwal , and Marc Cohen Metrics 1 December 2020Volume 173, Issue 11Page: 944-945KeywordsEchocardiographyForecastingIschemiaIschemic strokeMigraineMorbidityNeuroimagingStrokeTransient ischemic attacksUltrasound imaging ePublished: 1 December 2020 Issue Published: 1 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...