title: The association of different right atrium anatomical-functional characteristics correlates with the risk of paradoxical stroke: an intracardiac echocardiographic study.
abstract: BACKGROUND
  The contribution of different right atrium anatomical-functional characteristics to the risk of paradoxical stroke has not been extensively investigated, probably in part because of the limits of standard echocardiography.
  
  
  OBJECTIVE
  We sought to assess, using intracardiac echocardiography (ICE), the right atrium anatomical-functional characteristics and their role in the pathophysiology of paradoxical embolism in a sample of patent foramen ovale (PFO) patients undergoing transcatheter PFO closure.
  
  
  METHODS
  Over a 36-month period, we prospectively enrolled 114 consecutive patients (mean age 38+/- 10.5 years, 67 female) referred to our center for PFO catheter-based closure. On ICE study, all sensible characteristics other than PFO and mild ASA were recorded, including prominent EV or large CN, basal shunt without Valsalva maneuver, moderate to severe ASA, and multiperforated fossa ovalis.
  
  
  RESULTS
  After TEE and ICE study and measurements, a prominent EV or CN was diagnosed on ICE in 73%, a basal shunt was present in 48%, a moderate to severe ASA in 47%, and a multiperforated FO in 24% of patients. A tight correlation between number of concurrent factors and proportion of patients with curtain pattern on TC Doppler, larger right-to-left shunt, recurrent cerebral paradoxical embolism before closure, and migraine with aura was clearly evident (r > or = 0.97). Basal shunt and concurrent > or = 3 anatomical functional right atrium characteristics resulted as independent predictors of recurrent paradoxical embolisms.
  
  
  CONCLUSIONS
  Our data suggest that right atrium anatomical-functional characteristics other than PFO and mild ASA as assessed by ICE deeply affect the pathophysiology of paradoxical stroke.
authors.affiliation: Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. jackyheart@hotmail.com
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rigatelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Cardaioli
authors.forename: Fabio
authors.initials: F
authors.lastname: Dell'Avvocata
authors.forename: Massimo
authors.initials: M
authors.lastname: Giordan
authors.forename: Gabriele
authors.initials: G
authors.lastname: Braggion
authors.forename: Silvio
authors.initials: S
authors.lastname: Aggio
authors.forename: Mauro
authors.initials: M
authors.lastname: Chinaglia
authors.forename: Loris
authors.initials: L
authors.lastname: Roncon