This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Holmes, D. R. Articles by Cabalka, A. Search for Related Content PubMed PubMed Citation Articles by Holmes, D. R., Jr Articles by Cabalka, A. Related Collections Catheter-based coronary and valvular interventions: other Acute Stroke Syndromes Transient Ischemic Attacks

(Circulation. 2002;106:1034.)
© 2002 American Heart Association, Inc.

Editorial

Was Your Mother Right—

Do We Always Need to Close the Door?

David R. Holmes, Jr, MD; Allison Cabalka, MD

From the Division of Cardiovascular Diseases and Internal Medicine (D.R.H.) and Division of Pediatric Cardiology and Pediatrics (A.C.), Mayo Clinic, Rochester, Minn.

Correspondence to David R. Holmes, Jr, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Key Words: Editorials • stroke • pathology • heart defects, congenital • cerebral ischemia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Stroke remains one of the most feared and devastating complications for patients to envisage. This remains true regardless of the age of the patient and the presence or absence of comorbidities, but it may be relatively more important the younger the patient is. Establishing the pathogenesis of stroke is fundamentally important for attempts at prevention. In some patients, the diagnosis of the underlying cause is relatively straightforward—eg, the presence of a high-grade, ulcerated lesion in the carotid artery in the distribution of the central nervous system symptoms or neurological deficit. In other cases, it may be considerably more difficult; then, the question of a cardiac source is often raised.

See p 1121

Echocardiography has become an integral part of the evaluation in many such patients. Early in the history of this field, attention was focused on the left atrial appendage as a putative source. In addition, however, abnormalities of the atrial septum were documented and have since come to occupy an important position. These abnormalities were further characterized after the introduction of contrast studies and transesophageal echocardiography, which helped in the documentation of patent foramen ovale (PFO), atrial septal aneurysm (ASA), and right-to-left shunt. In such patients, emboli potentially could pass from the venous to the systemic arterial circulation.^1,2 It must be remembered that there may be other mechanisms, including thrombus forming in the ASA or thrombus from supraventricular arrhythmias. In a recent meta-analysis,³ there were 2738 references of case-control studies that identified the keywords PFO, ASA, or right-to-left shunt. . . . [Full Text of this Article]

This article has been cited by other articles:

				I. Meissner, B. K. Khandheria, J. A. Heit, G. W. Petty, S. G. Sheps, G. L. Schwartz, J. P. Whisnant, D. O. Wiebers, J. L. Covalt, T. M. Petterson, et al. Patent Foramen Ovale: Innocent or Guilty?: Evidence From a Prospective Population-Based Study J. Am. Coll. Cardiol., January 17, 2006; 47(2): 440 - 445. [Abstract] [Full Text] [PDF]

				B. Meier Patent Foramen Ovale, Guilty But Only as a Gang Member and for a Lesser Crime J. Am. Coll. Cardiol., January 17, 2006; 47(2): 446 - 448. [Full Text] [PDF]

				H. P. Adams Jr Patent Foramen Ovale: Paradoxical Embolism and Paradoxical Data Mayo Clin. Proc., January 1, 2004; 79(1): 15 - 20. [PDF]

				J. Resley, D. Fitzgerald, R. Albus, and P. Massimiano Pericardial patch closure of an atrial septal defect using endoscopic robotic technology Perfusion, December 1, 2003; 18(6): 365 - 367. [Abstract] [PDF]