Patent Foramen Ovale and Risk of Perioperative Stroke

To the Editor Dr Ng and colleagues reported that having a patent foramen ovale (PFO) diagnosed preoperatively was associated with an increased risk of stroke occurring within 30 days after noncardiac surgery. The diagnosis of PFO was made only by transthoracic or transesophageal echocardiography without any evaluation of the magnitude of right-to-left shunting. Moreover, presence and severity of atrial septal aneurysm was not recorded as a risk factor. Large or permanent right-to-left shunting graded either by transcranial Doppler or transthoracic echocardiography bubble test has been associated with an increased risk of paradoxical embolism compared with mild right-to-left shunt. Large atrial septal aneurysms have been associated with an increased risk of paradoxical embolism compared with mild or no aneurysm.
Source: JAMA - Category: General Medicine Source Type: research