Stroke: patent foramen ovale was present in ischaemic stroke patients.

Clinical bottom line (level 4)

  1. A tenth of patients under 55 years old waiting for posterior fossa surgery without prior ischaemic stroke have patent foramen ovale diagnosed by contrast echocardiography.
  2. More than a third of patients under 55 years old with ischaemic stroke have patent foramen ovale diagnosed by contrast echocardiography.
Lechat et al: New England Journal of Medicine 1988; 318: 1148-1152
Expires December 2002

The study

Setting: general hospital, France

170 patients (aged mean age 38 years, 55% male) History of completed ischaemic stroke (n=70). Controls (n=100) with no history of stroke.

Excluded if
  • > 55 years old
  • abnormal cardiac status on admission
  • poor quality echocardiographs.



    • Independent ?blinded reference standard, applied in all patients from a ?consecutive inappropriate spectrum.
    Diagnostic test: Two-dimensional contrast echocardiography which requires intravenous administration of an echo-detectable contrast material. A rapid injection of 5 to 10 ml of isotonic saline containing air microbubbles is used for this. In the presence of patent foramen ovale, microbubbles may appear in the left-sided cavities of the heart. Echocardiography can be used during the Valsalva maneuver or cough test.
    • All of the 100 control patients were candidates for posterior fossa surgery.

    The evidence


    differential diagnosis number of patients prevalence
    (95% CI)
    patent foramen ovale in controls 10 10.0%
    (4.12% to 15.9%)
    patent foramen ovale in stroke patients 24 40.0%
    (27.6% to 52.4%)

    • Prevalence of mitral-valve prolapse was significantly higher in patients with stroke than in controls (15% compared with 4%).

    Citation

    1. Lechat PH, Mas JL, Lascault G, et al: Prevalence of patent foramen ovale in patients with stroke. New England Journal of Medicine 1988; 318: 1148-1152
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient young adults with stroke
    Intervention or Exposure presence of patent foramen ovale
    Comparison absence of patent foramen ovale
    Outcome prevalence