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Original Research

Open Access

Morphometric characteristics of interatrial septum in patients with patent foramen ovale and cryptogenic stroke

  • Qingyuan Zhang1,†
  • Yudong Peng1,†
  • Hong Zhang1
  • Xiaoling Wan1
  • Xiao Liu1
  • Wei Xu1,*,

1Department of Ultrasonography, The First Affiliated Hospital of Yangtze University, 434021 Jingzhou, Hubei, China

DOI: 10.22514/sv.2023.016 Vol.19,Issue 2,March 2023 pp.82-90

Submitted: 31 August 2022 Accepted: 01 November 2022

Published: 08 March 2023

*Corresponding Author(s): Wei Xu E-mail:

† These authors contributed equally.


High-risk morphometric characteristics of patent foramen ovale (PFO), as observed by transesophageal echocardiography (TEE), are associated with cryptogenic stroke (CS) and crucial for selecting optimal treatment. This study aimed to evaluate the pathogenic characteristics and mobility of the interatrial septum (IAS) in patients with PFO and CS. The PFO parameters of 69 patients, including 32 patients with CS and 37 without CS, were assessed using TEE to determine the degree of mobility and pathogenic characteristics. CS patients had more significant IAS mobility, shorter PFO length and thinner septum primum thickness than non-CS patients. Multivariate analysis showed that age, IAS mobility, PFO length and septum primum thickness were independently associated with CS. No correlation was found in the mobility of the middle and edge of the septum primum and septum secundum in both groups of patients. TEE could accurately identify the morphometric characteristics of PFO. CS was associated with PFO characteristics, including age, IAS mobility, PFO length and septum primum thickness.


Interatrial septum; Patent foramen ovale; Cryptogenic stroke; Transesophageal echocardiography

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Qingyuan Zhang,Yudong Peng,Hong Zhang,Xiaoling Wan,Xiao Liu,Wei Xu. Morphometric characteristics of interatrial septum in patients with patent foramen ovale and cryptogenic stroke. Signa Vitae. 2023. 19(2);82-90.


[1] Søndergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. The New England Journal of Medicine. 2017; 377: 1033–1042.

[2] Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. The New England Journal of Medicine. 2017; 377: 1022–1032.

[3] Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. The New England Journal of Medicine. 2017; 377: 1011–1021.

[4] Webster MW, Chancellor AM, Smith HJ, Swift DL, Sharpe DN, Bass NM, et al. Patent foramen ovale in young stroke patients. Lancet. 1988; 2: 11–12.

[5] Hołda M, Koziej M. Morphometric features of patent foramen ovale as a risk factor of cerebrovascular accidents: a systematic review and meta-analysis. Cerebrovascular Diseases. 2020; 49: 1–9.

[6] Lee PH, Song JK, Kim JS, Heo R, Lee S, Kim DH, et al. Cryptogenic stroke and high-risk patent foramen ovale: The DEFENSE-PFO Trial. Journal of the American College of Cardiology. 2018; 71: 2335–2342.

[7] Windecker S, Stortecky S, Meier B. Paradoxical embolism. Journal of the American College of Cardiology. 2014; 64: 403–415.

[8] Turc G, Lee J, Brochet E, Kim JS, Song J, Mas J. Atrial septal aneurysm, shunt size, and recurrent stroke risk in patients with patent foramen ovale. Journal of the American College of Cardiology. 2020; 75: 2312–2320.

[9] Zhu Y, Zhang J, Huang B, Liu Y, Deng Y, Weng Y, et al. Impact of patent foramen ovale anatomic features on right-to-left shunt in patients with cryptogenic stroke. Ultrasound in Medicine & Biology. 2021; 47: 1289–1298.

[10] Nakayama R, Takaya Y, Akagi T, Watanabe N, Ikeda M, Nakagawa K, et al. Identification of high-risk patent foramen ovale associated with cryptogenic stroke: development of a scoring system. Journal of the American Society of Echocardiography. 2019; 32: 811–816.

[11] Natanzon A, Goldman ME. Patent foramen ovale: anatomy versus pathophysiology—which determines stroke risk? Journal of the American Society of Echocardiography. 2003; 16: 71–76.

[12] Ahmad Y, Howard JP, Arnold A, Shin MS, Cook C, Petraco R, et al. Patent foramen ovale closure vs. medical therapy for cryptogenic stroke: a meta-analysis of randomized controlled trials. European Heart Journal. 2018; 39: 1638–1649.

[13] Homma S, Messé SR, Rundek T, Sun Y, Franke J, Davidson K, et al. Patent foramen ovale. Nature Reviews Disease Primers. 2016; 2: 15086.

[14] Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24: 35–41.

[15] Akhondi A, Gevorgyan R, Tseng C, Slavin L, Dao C, Liebeskind DS, et al. The association of patent foramen ovale morphology and stroke size in patients with paradoxical embolism. Circulation: Cardiovascular Interventions. 2010; 3: 506–510.

[16] Mügge A, Daniel WG, Angermann C, Spes C, Khandheria BK, Kronzon I, et al. Atrial septal aneurysm in adult patients. A multicenter study using transthoracic and transesophageal echocardiography. Circulation. 1995; 91: 2785–2792.

[17] Musto C, Cifarelli A, Dipasquale F, Chin D, Nazzaro MS, Stio RE, et al. A comparison between gore cardioform and amplatzer septal occluder for percutaneous closure of patent foramen ovale associated with atrial septal aneurysm: clinical and echocardiographic outcomes. The Journal of Invasive Cardiology. 2021; 33: E857–E862.

[18] de Belder MA, Tourikis L, Leech G, Camm AJ. Risk of patent foramen ovale for thromboembolic events in all age groups. The American Journal of Cardiology. 1992; 69: 1316–1320.

[19] Pearson AC, Labovitz AJ, Tatineni S, Gomez CR. Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. Journal of the American College of Cardiology. 1991; 17: 66–72.

[20] Kent DM, Saver JL, Kasner SE, Nelson J, Carroll JD, Chatellier G, et al. Heterogeneity of treatment effects in an analysis of pooled individual patient data from randomized trials of device closure of patent foramen ovale after stroke. JAMA. 2021; 326: 2277–2286.

[21] Cohnheim JF. Thrombose und Embolie. In: Vorlesungenüber Allgemeine pathologie. Berlin: Hirschwald. 1877; 1: 134.

[22] Rigatelli G, Dell’Avvocata F, Cardaioli P, Giordan M, Braggion G, Aggio S, et al. Permanent right-to-left shunt is the key factor in managing patent foramen ovale. Journal of the American College of Cardiology. 2011; 58: 2257–2261.

[23] Yan C, Li H. Preliminary investigation of in situ thrombus within patent foramen ovale in patients with and without stroke. JAMA. 2021; 325: 2116–2118.

[24] Bang OY, Lee MJ, Ryoo S, Kim SJ, Kim JW. Patent foramen ovale and stroke-current status. Journal of Stroke. 2015; 17: 229–237.

[25] Rigatelli G, Aggio S, Cardaioli P, Braggion G, Giordan M, Dell’avvocata F, et al. Left atrial dysfunction in patients with patent foramen ovale and atrial septal aneurysm: an alternative concurrent mechanism for arterial embolism? JACC: Cardiovascular Interventions. 2009; 2: 655–662.

[26] Klimek-Piotrowska W, Hołda MK, Koziej M, Piątek K, Hołda J. Anatomy of the true interatrial septum for transseptal access to the left atrium. Annals of Anatomy. 2016; 205: 60–64.

[27] Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Archives of Internal Medicine. 1991; 151: 933–938.

[28] Homma S, DiTullio MR, Sacco RL, Sciacca RR, Mohr JP. Age as a determinant of adverse events in medically treated cryptogenic stroke patients with patent foramen ovale. Stroke. 2004; 35: 2145–2149.

[29] Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clinic Proceedings. 1984; 59: 17–20.

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