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Updated: Jun 26, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Morphological Features of Patent Foramen Ovale Compared Between Older and Young Patients With Cryptogenic Ischemic
Mitsutaka Nakashima1, Yoichi Takaya1, Rie Nakayama1
1Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Insights
High-risk patent foramen ovale (PFO) morphologies are common in older patients with cryptogenic stroke (CS). These findings are similar to younger patients, informing PFO closure decisions.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Patent foramen ovale (PFO) morphology influences cryptogenic stroke (CS) risk and transcatheter closure decisions.
- Limited data exist on PFO morphology in older CS patients, with most studies focusing on younger populations.
- Understanding PFO characteristics in elderly CS patients is crucial for appropriate treatment selection.
Purpose of the Study:
- To compare the prevalence of high-risk PFO morphologies in older (≥60 years) versus younger (<60 years) patients with a history of CS.
- To assess septal malalignment and PFO-Associated Stroke Causal Likelihood in these age groups.
Main Methods:
- Transesophageal echocardiography was used to assess PFO morphology in 169 patients with CS and PFO.
- Patients were stratified into two age groups: ≥60 years and <60 years.
- The PFO-Associated Stroke Causal Likelihood classification system was employed.
Main Results:
- Older patients (≥60 years) showed a significantly higher prevalence of atrial septal aneurysm compared to younger patients.
- No significant differences were observed in the prevalence of large right-to-left shunt, long PFO tunnel, Eustachian valve, or Chiari's network between age groups.
- Septal malalignment was more frequent in patients aged ≥60 years, with nearly 90% classified as 'possible' CS risk.
Conclusions:
- High-risk PFO morphologies are prevalent in older patients with CS, similar to younger cohorts.
- Age does not significantly alter the prevalence of certain PFO features like shunts or tunnels.
- Findings support the consideration of PFO closure in older CS patients with identified high-risk morphologies.
Background:
The morphology of a patent foramen ovale (PFO) with a high-risk for cryptogenic ischemic stroke (CS) is an important factor in the selection of patients for transcatheter closure, but the morphological features of PFO in older patients with a history of CS are less known because the most data are obtained from younger patients.
Methods And Results:
The study included 169 patients who had a history of CS and PFO. The prevalence of high-risk morphologies of PFO assessed by transesophageal echocardiography was compared between patients aged ≥60 years and patients aged <60 years. We also assessed the presence of septal malalignment of PFO on the aortic wall. The probability of CS due to PFO was evaluated using the PFO-Associated Stroke Causal Likelihood classification system. Patients aged ≥60 years had a significantly higher prevalence of atrial septal aneurysm than patients aged <60 years. The prevalence of large right-to-left shunt, long-tunnel of PFO, or Eustachian valve or Chiari's network was similar between patients aged ≥60 years and <60 years. Septal malalignment was observed more frequently in patients aged ≥60 years than in those <60 years old. Nearly 90% of patients aged ≥60 years were classified as 'possible' in the PFO-Associated Stroke Causal Likelihood classification system.
Conclusions:
High-risk morphologies of PFO are common in older patients with a history of CS, as well as in younger patients.
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