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PATENT FORAMEN OVALE AND ISCHAEMIC STROKE IN YOUNG ADULTS – A RETROSPECTIVE STUDY
ROK ARH
orcid.org/0000-0003-3275-8409
; University of Maribor, Faculty of Medicine, Maribor, Slovenia
MARIJA MENIH
orcid.org/0000-0002-9381-6222
; Maribor University Medical Centre, Maribor, Slovenia
LUCIJA JAZBEC
orcid.org/0000-0002-1232-6740
; University of Maribor, Faculty of Medicine, Maribor, Slovenia
Abstract
Objective: Ischaemic stroke is the most common type of stroke. One of the risk factors is patent foramen ovale (PFO), which is normally open in parallel intrauterine circulation and represents the right-to-left fl ow (shunt), and is closed by the septum primum tissue or persists after establishment of postpartum circulation. If it does not close at the end of the fi rst year, it is called atrial septal defect (ASD) and represents left-to-right fl ow in circulation. This defect remains open with varying degrees of leftto-right fl ow in some patients. It is thought to be present in about 50% of young patients who experience ischaemic stroke. It is caused by the mechanism of paradoxical embolization, but by the right-to-left fl ow. The factors affecting the likelihood of stroke in these patients are as follows: PFO size, increase in the right atrial pressure due to various factors that may transiently cause right-to-left fl ow, or even open virtually closed fossa ovalis. A possible concomitant aneurysm of the interatrial septum
at the level of fossa ovalis has a special place in the development of paradoxical embolism. The accompanying factors that increase the likelihood of ischaemic stroke in patients with PFO are severe physical exertion, agitation, pulmonary hypertension, immobilisation, pregnancy, and congenital or acquired coagulation disorders. Methods: This retrospective study was based on the analysis of patients aged 18-49 years hospitalised due to ischaemic stroke at the Maribor University Medical Centre in the period from 2010 to 2019 inclusive. Differences between the 2 groups were analysed. Group 1 consisted of patients with proven PFO and group 2 of patients in whom no right-to-left fl ow was demonstrated. The results of the research were analysed by JASP 0.14.1. and IBM SPSS Statistics 28 software. The level of statistical signifi cance was set at p<0.05. Results: This study included 196 patients with 198 ischaemic stroke events. PFO was present in 23 (11.7%) patients. Arterial hypertension was more common in group 2 patients (17.4% vs. 53.2%, p<0.05). Group 1 patients were signifi cantly younger than group 2 patients (36.478 (7.223) vs. 42.214 (7.043) years, p<0.05). Disease outcome was more favourable in group 1 as compared with group 2 patients (1.000 (0.603) vs. 1.728 (1.574), p<0.05). Conclusions: Persistent foramen ovale is a more common cause of ischaemic stroke in younger people and plays a key role in this age group. Arterial hypertension is probably a more common cause of ischaemic stroke in elderly patients. The outcome of the disease is more favourable in the group of patients with PFO.
Keywords
ischaemic stroke; patent foramen ovale; young adults, risk factors; paradoxical embolism
Hrčak ID:
280167
URI
Publication date:
7.7.2022.
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