Title : The Incidence and Characteristics of Patent Foramen Ovale in patients with Embolic Stroke of Undetermined Source
Patent Foramen Ovale (PFO) has been associated with Embolic Stroke of Undetermined Source (ESUS). It remains uncertain whether PFO is the direct etiology or an incidental finding. The aim of our study was to analyze the incidence and characteristics of PFO in patients with ESUS .
A prospective Tunisian study was conducted from 2017 to 2020. ESUS was defined according to the criteria proposed by the Cryptogenic Stroke /ESUS International Working Group . According to these criteria, all patients underwent a transthoracic echocardiography (TTE). To detect a PFO, we performed a microbubble test with a Valsalva maneuver. Once detected by the TTE , the characteristics of PFO ( diameter, coexistence of an atrial septal aneurysm or hypermobile septum) were analyzed by a Transesophageal echocardiography (TEE) .
We studied 66 patients (68.2% men ; mean age= 57.1+/-11 years) with acute ESUS within 1 week of admission. Of these, 16 (24.2%) were identified by TTE and /or TEE to have a PFO. PFO was > 2 mm in diameter in 4(25%) patients ,and atrial septal aneurysms or hypermobile septa were observed in 4 (25%) patients . Three patients had either a large PFO (> 2 mm in diameter) and an atrial septal aneurysm.
The presence of PFO may be a likely embolic source or a risk factor in patients with ESUS. More prospective studies are necessary to study the association between PFO and ESUS.