Prevalence of atrial septal defects and patent foramen ovale in a large cohort of sudden cardiac death patients undergoing autopsy

Abstract

Abstract Background The prevalence of patent foramen ovale and atrial septal defects has previously been described in early autopsy series and transoesophageal echocardiograms as ranging from 25 to 30%. Updated pathologic data is lacking. Methods A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1 to 50 years who experienced a sudden cardiac arrest in Victoria, Australia from April 2019 to April 2022 and subsequently underwent autopsy with a cardiac cause of death identified. A comprehensive autopsy assessment was performed including visual description of any atrial septal defect and identification of probe patency of the foramen ovale. Results 517 patients underwent autopsy in the setting of sudden cardiac death with documentation of their atrial septal status. 36 patients (6.9%) had a probe-patent foramen ovale, 2 patients (0.4%) had secundum atrial septal defects, and 2 patients (0.4%) had a simultaneous atrial septal defect and patent foramen ovale (1 of whom had undergone percutaneous repair of both lesions). 12 patients (2.3%) had a prior history of cerebrovascular accident either recorded on medical history or detected on neuropathological examination; however none of these patients had atrial septal defects or patent foramen ovale. Conclusions The combined rate of atrial septal defects and patent foramen ovale in a cohort of approximately 500 patients undergoing autopsy was 7.7%. None of these patients had experienced a cerebrovascular accident. This appears lower than earlier reports, and warrants further investigation in expanded cohorts of patients.