title: The association of patent foramen ovale morphology and stroke size in patients with paradoxical embolism.
abstract: BACKGROUND
  Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke through paradoxical embolization to the cerebral circulation. This study evaluated the relationship between the morphological and functional size of the PFO by echocardiography compared with cerebral infarct volume identified on MRI.
  
  
  RESULTS
  Patients who were referred to interventional cardiology with the diagnosis of cryptogenic stroke were included and had either a transesophageal echocardiogram or an intracardiac echo and a brain MRI at the time of stroke. Transesophageal echocardiogram or intracardiac echo was used to obtain PFO measurements. MRI of the brain with 3 sequences (T2, diffusion-weighted imaging, and fluid-attenuated inversion recovery) was used to diagnose acute stroke and measure the infarct volume. In the 72 patients studied, the median measured stroke volume was 4.3 cm(3) on diffusion-weighted imaging, 4.1 cm(3) on T2, and 3.5 cm(3) on fluid-attenuated inversion recovery. There was no significant correlation between the PFO height, length, septum secundum thickness, or echo bubble grade and the infarct volume measured from the 3 MRI sequences. There was a significant correlation between septal excursion distance and infarct volume (r=0.35; P=0.005), but the 12 patients with atrial septal aneurysm did not have the largest strokes.
  
  
  CONCLUSIONS
  This analysis revealed that septal excursion distance correlates with stroke size by MRI. However, smaller PFO size without the presence of atrial septal aneurysm may still be associated with significant strokes. There was no significant association between PFO height, length by echo, or shunt grade by transcranial Doppler study and brain infarct volume. Therefore, PFO size or morphology should not be the only criteria to decide whether a PFO should be closed.
authors.affiliation: Department of Medicine, Cardiology Division, David Geffen School of Medicine at UCLA, Los Angeles, Calif., USA. aakhondi@ucla.edu
authors.forename: Andre
authors.initials: A
authors.lastname: Akhondi
authors.forename: Rubine
authors.initials: R
authors.lastname: Gevorgyan
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Leo
authors.initials: L
authors.lastname: Slavin
authors.forename: Catherine
authors.initials: C
authors.lastname: Dao
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Tobis
mesh_terms: D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000473:pathology*; D006343:Heart Septal Defects / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D013318:Stroke Volume