Hanna J P, Sun J P, Furlan A J, Stewart W J, Sila C A, Tan M
Department of Neurology, Cleveland Clinic Foundation, Ohio 44195.
Stroke. 1994 Apr;25(4):782-6. doi: 10.1161/01.str.25.4.782.
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.
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 cardio-embolic 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.
Atrial septal aneurysms were more common in group 1 (38%) compared with group 2 (10%) and group 3 (8%) (P = .02). Contrast right-to-left shunting occurred in 88% of group 1 (P = .06) and 86% of group 2 (P = .07) compared with 60% of group 3. Prevention of recurrence in subjects with presumed patent foramen ovale-related brain infarcts varied. Aspirin was usually chosen after initial brain ischemia. Warfarin and patent foramen ovale closure were usually reserved for subjects with symptoms of brain ischemia while taking aspirin or those who required warfarin or cardiac surgery for other indications. No recurrent infarcts occurred in 15 patients during a mean follow-up period of 28 months.
Atrial septal aneurysm and right-to-left shunt may be predictive of a patent foramen ovale that predisposes a patient to stroke. Aspirin may provide sufficient infarct prophylaxis after initial ischemia. Warfarin and surgical correction should likely be reserved for those in whom aspirin is not effective or those who require warfarin or cardiac surgery for other reasons until prospective studies are available.
通过未闭卵圆孔的反常栓塞是公认的卒中病因，但尚未确定未闭卵圆孔患者的临床预测因素、复发率及脑梗死的预防方法。我们回顾经食管超声心动图记录，以确定未闭卵圆孔相关梗死的超声心动图预测因素及最佳预防措施。
在60个月期间的615次经食管超声心动图检查中，通过彩色多普勒或盐水造影在74例患者中发现了未闭卵圆孔。根据最终临床情况，将患者分为以下几组：第1组，梗死且未闭卵圆孔可能为病因（n = 16）；第2组，梗死但未闭卵圆孔不太可能为病因（n = 23）；第3组，无梗死（n = 35）。在不了解临床细节或分组情况的前提下，回顾经食管超声心动图以评估未闭卵圆孔特征及相关的心源性栓塞来源。在第1组的16例患者中，通过电话或书面通信对15例未闭卵圆孔相关梗死患者进行了随访。
与第2组（10%）和第3组（8%）相比，第1组房间隔瘤更为常见（38%）（P = .02）。与第3组的60%相比，第1组88%（P = .06）和第2组86%（P = .07）出现了对比剂右向左分流。对推测为未闭卵圆孔相关脑梗死患者的复发预防措施各不相同。初次脑缺血后通常选择阿司匹林。华法林和未闭卵圆孔封堵术通常用于服用阿司匹林时出现脑缺血症状的患者或因其他适应证需要华法林或心脏手术的患者。15例患者在平均28个月的随访期内未发生复发性梗死。
房间隔瘤和右向左分流可能提示未闭卵圆孔使患者易患卒中。初次缺血后阿司匹林可能提供足够的梗死预防作用。在有前瞻性研究之前，华法林和手术矫正可能应保留用于阿司匹林无效的患者或因其他原因需要华法林或心脏手术的患者。
