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Background: Detailed multidimensional assessment of patent foramen ovale (PFO) size with transesophageal echocardiography (TOE) may help to determine PFO pathogenicity in cryptogenic stroke patients. We explored the potential additive value of Live xPlane and three‐dimensional (3D) TOE anatomical PFO sizing techniques. Methods: Imaging data of 45 patients who underwent a 3D TOE‐assisted percutaneous PFO closure were studied. The two‐dimensional (2D) PFO separation distance and right‐to‐left (RL) contrast shunt magnitude were assessed on preprocedural TOE recordings. Peri‐procedural measurements of the triangular anatomical PFO opening (base, height, and area) were performed after positioning of a stiff guidewire (SW) through the PFO, using Live xPlane imaging and 3D Zoom mode. Results: The PFO SW base appeared on average 5 times larger than the preprocedural 2D PFO separation (median difference [IQR] = 13[5] mm; P <.001). For a same PFO separation, the width of the PFO base may vary significantly. The PFO SW base was significantly larger in patients with a large versus a small‐to‐moderate PFO RL contrast shunt (18 vs 15 mm; P =.007) and in those with a spontaneous versus a provoked shunt (18 vs 14 mm; P =.003). Conclusion: Live xPlane and 3D Zoom TOE allow peri‐procedural measurement of the largest dimension of a PFO, which is the PFO base. Patients with a large or spontaneous RL contrast shunt appear to have a larger PFO base. The anatomical PFO base dimension may be taken into account for optimization of device and patient selection strategies. [ABSTRACT FROM AUTHOR]

Background: Dilatation of the ascending aorta has an important role in the anatomical conformation of interatrial septum (IAS) especially when a patent foramen ovale (PFO) is present. The aim of the study was to investigate the relationship between ascending aortic dilation and PFO‐related cryptogenic stroke in a cohort of cryptogenic strokes. Methods: It is a retrospective, single‐center echocardiographic study assessing aortic root dilatation in 315 consecutive patients with cryptogenic stroke between January 2011 and January 2019. Aortic root dilatation was defined by a diameter of the Valsalva sinuses of the proximal aorta >40 mm. Predictive factors of PFO were assessed by a multivariate analysis. Propensity score matching was applied to account for clinical differences. Results: Of the 315 patients, 68 (22%) had an aortic root dilatation and 167 (53%) had a PFO. In the aortic root dilation group, PFO was more often diagnosed (n = 47/68 [69%], vs n = 120/247 [49%], P =.004). In the PFO group with aortic dilatation, IAS was more mobile (n = 37/47[79%] vs n = 69/120[57%], P <.012) and smaller (2.3 ± 0.5 vs 2.5 ± 0.5 mm, P <.009). On multivariate analysis, aortic root dilatation (OR: 2.6; 95% CI [1.2–5.6]; P =.001) and IAS hypermobility (OR: 5.2 95% CI [2.7–10]; P =.001) were associated with PFO. After propensity matching, aortic root dilatation remained strongly associated with PFO (n = 34/107 [32%] vs 15/107[14%], P =.002). Conclusion: Aortic root dilation and IAS hypermobility were strongly associated with PFO‐related cryptogenic stroke. [ABSTRACT FROM AUTHOR]

We report a rare case of abrupt formation of intracardiac thrombus during patent foramen ovale closure by three‐dimensional transesophageal echocardiography. This case highlights transesophageal echocardiography allows timely detection and management of intracardiac thrombus formation. [ABSTRACT FROM AUTHOR]