Left atrial dysfunction in patients with patent foramen ovale and atrial septal aneurysm scheduled for transcatheter closure may play a role in aura genesis.
BACKGROUND
It has been suggested that a left atrial (LA) dysfunction induced by large shunt and large atrial septal aneurysm (ASA) may act as a concurrent mechanism of arterial embolism in patients with patent foramen ovale (PFO) and prior stroke. We aimed to evaluate the potential contribution of this mechanism as trigger of migraine in patients with PFO.


METHODS
From January 2007 to September 2009, we prospectively enrolled subjects with migraine who underwent percutaneous PFO closure. Echocardiographic parameter of LA dysfunction was evaluated: pre- and postoperative values were compared to values of different sex and heart rate matched populations: 30 healthy patients, 21 migraine patients without PFO (MwoPFO), and a group of 25 PFO patients without migraine (PFOwoM). The Migraine Disability Assessment Score (MIDAS) was used to assess the incidence and severity of migraine.


RESULTS
Forty-five patients (38 females, mean age 38 +/- 6.7 years, mean MIDAS 35.8 +/- 4.7, and 28 patients with migraine with aura) fulfilled the inclusion criteria. After successful percutaneous closure (mean follow-up of 18.2 +/- 4.8 months), PFO closure remained complete in 95%; 35 of 45 patients reported resolution or amelioration of migraine (mean MIDAS score 12.3 +/- 8.8, P < 0.03). All patients with aura reported aura resolution. Preclosure values demonstrated significantly greater LA dysfunction, when compared with healthy and MwoPFO groups. Among patients in the study group, only patients with migraine with aura showed LA dysfunction comparable to PFOwoM patients.


CONCLUSIONS
This study suggests that LA dysfunction probably does not contribute to migraine itself but may play a role in the genesis of aura symptoms.
Rigatelli
Gianluca
G
Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. jackyheart@libero.it
Dell'avvocata
Fabio
F
Cardaioli
Paolo
P
Ronco
Federico
F
Giordan
Massimo
M
Braggion
Gabriele
G
Aggio
Silvio
S
Chinaglia
Mauro
M
Cheng
Jack P
JP
Nanjundappa
Aravinda
A
D000328:Adult; D016279:Atrial Function, Left / Q000502:physiology*; D016022:Case-Control Studies; D005260:Female; D054092:Foramen Ovale, Patent / Q000503:physiopathology* / Q000601:surgery; D006322:Heart Aneurysm / Q000503:physiopathology* / Q000601:surgery; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D020325:Migraine with Aura / Q000503:physiopathology*; D011446:Prospective Studies; D055989:Septal Occluder Device