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Patent Cardiac Foramen Ovale: Stroke Risk and Closure

J. P. Mohr, MD; and Shunichi Homma, MD
[+] Article, Author, and Disclosure Information

From College of Physicians and Surgeons of Columbia University; New York, NY 10032.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: J.P. Mohr, MD, Neurological Institute, College of Physicians and Surgeons of Columbia University, 710 West 168th Street, New York, NY 10032; e-mail, jpm10@columbia.edu.

Current Author Addresses: Dr. Mohr: Neurological Institute, College of Physicians and Surgeons of Columbia University, 710 West 168th Street, New York, NY 10032.

Dr. Homma: Cardiology Division, College of Physicians and Surgeons of Columbia University, 710 West 168th Street, New York, NY 10032.

Ann Intern Med. 2003;139(9):787-788. doi:10.7326/0003-4819-139-9-200311040-00015
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With increasingly sophisticated detection technology, patent cardiac foramen ovale has emerged from the arcane shadows of clinicopathologic conferences, where its diagnosis as a cause of embolic stroke was a challenge to the discussants (1). Given the common difficulties in finding a cause for ischemic stroke (2), demonstration of patent foramen ovale seems an acceptable explanation to most clinicians (3). No longer rarely diagnosed, patent foramen ovale is being increasingly documented by transesophageal echocardiography (TEE). The condition is best demonstrated by passage of microbubbles through the patent foramen ovale after intravenous injection of agitated saline. These same microbubbles, which spread widely through the systemic circulation, also reach the circle of Willis intracranially, a finding easily documented through transcranial Doppler techniques (45).

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