The important anatomical significance of the Patent Foramen Ovale by Real-time 3D TEE in Cryptogenic Stroke and Migraine

Abstract

Background:Patent Foramen Ovale (PFO) may be a flap valve depending on the pressure change between the left and right atrium to determine whether to open. The transesophageal echocardiogram (TEE) is the reference standard imaging modality for confirming the presence or absence of the PFO. There is a causal association between PFO and unexplained stroke.3D-TEE has been described to optimize the visualization of PFO. Methods: A total of 134 consecutive patients with cryptogenic stroke or migraine who had suspected PFO and underwent c-TCD, TTE and c- TEE. RLS grading of PFO at rest and Abdominal compression Valsalva maneuver was detected by c-TEE. Results: The long diameter of FO (1.74±0.3 VS 1.60±0.4, P=0.039), the short diameter of FO (1.12±0.3 VS 1.00±0.3, P=0.036), perimeter of FO (4.62±0.7 VS 4.22±1.0, P=0.026) and area (1.80±0.8 VS 1.35±0.8, P=0.05) of the FO were significantly larger in the larger RLS group. A larger proportion of Eustachian valve or a Chiari’s network(14.3% VS 3.5%,P=0.036), a larger proportion of in the Left funnelform (55.1% VS 16.3% P<0.001), a longer length of the PFO tunnel( 13.4±4.4 VS 7.8±2.5,P<0.001), a lower IVC-PFO angle (16.4±3.4 VS 20.3±7.7,P=0.001), higher proportion of LA Multiple exits of the tunnel (46.9% VS 14.3% ,P<0.001) .Multivariate regression analysis showed that male(HR:4.026,95%CI:0.883~18.361,P=0.072), age(HR:1.076,95%CI:1.002~1.155,P=0.045), the Left funnelform (HR:7.299,95%CI:1.585~33.618,P=0.011), a longer length of the PFO tunnel tunnel( HR:1.843,95%CI:1.404~2.418,P<0.001) and Multiple exits of the tunnel of LA (HR:8.544,95%CI:1.595~45.754,P=0.012) contributed to the occurrence of cerebral infarction. Conclusions: The larger the fossa oval, the easier it cause active and cause a large right-to-left shunt. the Left funnelform, a longer length of the PFO tunnel and Multiple exits of the tunnel of LA contribute CS.TEE can carefully observe the specific morphological characteristics of PFO, When these features appear on TEE, there is a strong correlation with CS.