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Crochetage Sign on Electrocardiography as a Diagnostic Marker of Patent Foramen Ovale

Suraj S Patel1, Matthew D Atienza2, Mark B Hellerman2

  • 1Renaissance School Medicine, Stony Brook University, Stony Brook, New York, USA.

JACC. Case Reports
|July 30, 2026
PubMed

Insights

Subtle electrocardiogram findings, like the crochetage sign, can indicate underlying structural heart disease. This case highlights how electrocardiogram interpretation aids in diagnosing conditions such as patent foramen ovale.

Area of Science:

  • Cardiology
  • Neurology
  • Diagnostic Imaging

Background:

  • A young male presented with acute neurologic symptoms.
  • Initial diagnostic tests were inconclusive.
  • Electrocardiogram revealed the crochetage sign in inferior leads.

Purpose of the Study:

  • To investigate the diagnostic utility of electrocardiogram findings.
  • To correlate electrocardiogram abnormalities with structural heart disease.
  • To highlight the significance of the crochetage sign.

Main Methods:

  • Electrocardiogram (ECG) interpretation.
  • Transthoracic echocardiography.
  • Agitated saline contrast study for interatrial shunting.

Main Results:

  • Electrocardiogram showed the crochetage sign.
  • Echocardiography identified an atrial septal aneurysm.
  • Evidence of interatrial shunting confirmed patent foramen ovale.

Conclusions:

  • The crochetage sign on ECG can suggest structural heart disease.
  • Early detection of patent foramen ovale is crucial.
  • Careful ECG interpretation is vital for diagnosis.
Abstract

Keywords:
PFOcrochetage signpatent foramen ovale

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