Patent Foramen Ovale and Brain Infarct

Background and Purpose Paradoxical embolism through a patent foramen ovale is a recognized cause of stroke, but clinical predictors, recurrence rate, and prevention of brain infarcts in patients with patent foramen ovale have not been determined. We reviewed transesophageal echocardiographic records to ascertain echocardiographic predictors and optimal prophylaxis for patent foramen ovale-related infarcts. Methods A patent foramen ovale was identified in 74 patients during 615 transesophageal echocardiograms by color Doppler or saline contrast during a 60-month period. On the basis of final clinical situation, the patients were divided into the following groups: group 1, infarct with patent foramen ovale a likely cause (n=16); group 2, infarct with patent foramen ovale an unlikely cause (n=23); and group 3, no infarct (n=35). Transesophageal echocardiograms were reviewed to assess patent foramen ovale characteristics and associated cardioembolic sources without knowledge of clinical details or group assignment. Follow-up after a patent foramen ovale-related infarct was obtained by telephone or written correspondence in 15 of 16 group 1 patients. Results Atrial septal aneurysms were more common in group 1 (38%) compared with group 2 (10%) and group 3