Clinical Characteristics Of Patent Foramen Ovale-associated Stroke In Middle And Young-aged Patients And Followed-up Of Efficacy After Transcatheter Closure

Background:Patent foramen ovale(PFO)is a common congenital heart disease that affects about 25% of healthy patient,and paradoxical embolism caused by PFO is considered to be an important cause of cryptogenic stroke(CS).In September 2017,the New England Journal of Medicine(NEJM)published the long-term follow-up results of the Close,Reduce,and Respect studies,and in 2018,the journal of the American College of Cardiology(JACC)published the Deffense study on high-risk PFO in Asians.Both of which showed that transcatheter closure of PFO was superior to drug therapy alone in reducing the risk of recurrence of stroke.Objectives:The purpose of this study was to investigate the clinical and imaging features of patent foramen ovale associated stroke,the effective occlusion rate,the recurrent of ischemic stroke and related complications.Methods:This study was a prospective study.Patients who were treated in the Department of Cardiology of the Second Affiliated Hospital of Nanchang University from March 2019 to July 2021 were successively enrolled and divided into two groups: PFO-associated stroke group and stroke combined with PFO group.1、The differences in clinical characteristics between the two groups were analyzed.2、Follow-up was performed to observe the effective occlusion rate,complications and recurrence of stroke in the PFO-associated stroke group.Results:1 、 In this study,18 patients with PFO-associated stroke were enrolled,including 10 males(55%),aged 13-78(43±19)years,PFO diameter 2-10(3.4±1.8)mm,2 patients(11%)with ASA,and 18 patients(100%)with massive RLS confirmed by c-TCD.2、There were 45 patients with stroke combined with PFO,including 37 male(82%),aged 40-79(58±12)years old,including 15 with hypertension(33%),15 patients with diabetes(33%),13 patients with hyperlipidemia(28%),27 patients with atherosclerosis(60%),PFO diameter of 1.5-6(2.1±0.9)mm,and 20 patients(44%)with a large number of RLS confirmed by c-TCD.3 、 All 17 PFO-associated stroke patients,except a 15-year-old female,received PFO occlusion.1 patient suffered from repeated pulmonary embolism(PE)and stroke after closure due to venous aneurysm of lower extremity.After thrombolysis and surgical resection of venous aneurysm of lower extremity,the patient recovered well.The postoperative follow-up period ranged from 2 to 21 months.The occluders were in good position,no occluder displacement was observed,there was no thrombosis on the surface of the occluders,and the structure of adjacent cardiac tissue was normal.There was no recurrence of stroke.Six months after interventional therapy,all patients(17 cases)completed c-TCD follow-up and24 h Holter-electrocardiogram.One case(1/17,5.8%)had moderate residual RLS,with effective occlusion rate of 94.2%(16/17).No new atrial fibrillation or arrhythmia occurred.Conclusions:1、There were significant differences in age,underlying disease,size of PFO and shunt volume between PFO-associated patients and stroke combined PFO patients.2 、 The efficacy of transcatheter PFO occlusion in the treatment of PFO-associated stroke is satisfactory in the near and middle term,but further long-term large-scale follow-up is still needed.