132 Aortic root dilatation in young stroke patients with patent foramen ovale

Abstract

No previous study has looked for an association between aortic dilatation and the clinical sequelae of patent foramen ovale (PFO), although a possible relation has been identified in case reports. The aim of this study was to compare aortic dimensions in patients with symptomatic PFO with healthy controls. Forty-seven consecutive patients were identified who (a) presented with cerebrovascular accident (CVA) assessed as most likely secondary to PFO (confirmed on bubble study), (b) were under 50 years old, (c) underwent percutaneous PFO closure, and (d) had stored transthoracic echocardiogram images of the aortic annulus and root, as well as 47 age-, sex- and BSA-matched healthy controls. Among the 47 patients, 35 patients (74%) also met the diagnostic criteria for atrial septal aneurysm (ASA). Aortic root diameters were greater in patients with PFO at all three levels. The difference (about 10%) was more marked at the levels of the sinuses of Valsalva (34 ± 4 mm vs. 31 ± 34 mm, p < 0.01), and in the proximal ascending aorta (32 ± 4 mm vs. 29 ± 3, p < 0.01), and more modest at the level of the aortic annulus (23 ± 3 mm vs. 22 ± 2 mm, p = 0.2). Left ventricular measurements showed that PFO patients did not have larger hearts overall (end-systolic diameter: 30 ± 4 mm vs. 32 ± 5 mm, p = 0.10, end-diastolic diameter: 48 ± 5 mm vs. 50 ± 4 mm respectively, p = 0.04). This study shows that aortic diameter is increased in young PFO patients who have sustained a CVA compared with healthy subjects. This association may be due to a mechanistic effect, or more probably to a common underlying tissue disorder. Our results support further research in this area.