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Searching for Patent Foramen Ovale in Patients with Stroke
- Shunichi Homma, MD;
- Marco DiTullo, MD; and
- Ralph Sacco, MD
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IN RESPONSE:
Other factors potentially associated with a cryptogenic stroke include intracardiac mass or thrombus [1] and aortic arch mass [2]. Pulmonary venous thrombi, described by Remenchik and colleagues [3], and peripheral embolization was not seen in our cohort but was mentioned in our article [4] as an infrequent cause of cerebral embolization. in vivo diagnosis, however, is difficult. Thrombi located close to the left atrium in major pulmonary veins may be detected by transesophageal echocardiography.
The epidemiologic evidence of a relation between patent foramen ovale and ischemic stroke has been established by us [4] and by others [5]. However, as Dr. Layne indicates, a cause-effect relation between patent foramen ovale and stroke has not been established in a single patient, partly because of limited knowledge of associated factors, such as the role of coexisting deep venous thrombosis or hypercoagulable states. We agree with Dr. Layne that contrast echocardiography and transesophageal echocardiography in all patients with cryptogenic stroke may not be cost-effective because of the lack of available therapy. They represent, however, the first necessary steps in obtaining further knowledge of the natural history of stroke in association with patent foramen ovale and of the effect of therapeutic interventions (anticoagulation, antiplatelet agents, or closure) on the stroke recurrence rate.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
