{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:27:27Z","timestamp":1788449247827,"version":"build-2803163510"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The underlying aetiology of ischaemic strokes is unknown in as many as 50% of cases. Patent foramen ovale (PFO) has become an increasingly recognised cause of ischaemic strokes in young patients. The present study aimed (1) to assess the frequency of transoesophageal echocardiography (TOE) performed and the proportion of PFOs detected in patients aged \u226460 years and (2) examine the effect of PFO closure on reducing stroke reoccurrence.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a retrospective clinical audit based on de-identified, secure medical records of the Canberra Hospital, Australia. A review of records was conducted on discharged patients aged 18\u201360 years admitted to the stroke unit following an ischaemic stroke episode between January 1, 2015, and December 31, 2018.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 214 acute ischaemic stroke patients were admitted to the stroke unit (mean age, 49.2 \u00b1 9.7 years). Concerning aetiology, 47.2% were cryptogenic in origin, whereas 52.8% had a stroke of a determined cause. 12 patients were diagnosed with a PFO and 7 venous thromboembolic events were identified, 1 in the cryptogenic group and 6 in the determined cause group. 91.7% of PFOs were diagnosed in patients with a cryptogenic stroke. Trans-thoracic echocardiography (TTE) was performed in 37.3% of patients and had detected 4 PFOs (sensitivity 27.3%, specificity 92.5%). TOE was performed in 26.2% of patients and had detected 11 PFOs (sensitivity 90.0%, specificity 100%). The number needed to treat to prevent the occurrence of an ischaemic stroke through PFO closure was estimated at 30.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>An inverse association between age and PFO presence was found in patients aged 18\u201360 years. Additionally, TOE was superior to TTE for detecting PFO, particularly in those with stroke of an undetermined cause. Our results suggest an increased need for TOE as a routine imaging procedure for acute ischaemic stroke patients aged \u226460.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0242885","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T13:27:54Z","timestamp":1606742874000},"page":"e0242885","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Role of transoesophageal echocardiography in detecting patent foramen ovale in stroke patients aged \u226460 years: A retrospective study"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7169-7077","authenticated-orcid":true,"given":"Reabal","family":"Najjar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"pone.0242885.ref001","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1002\/ana.410250410","article-title":"Infarcts of undetermined cause: the NINCDS Stroke Data Bank","volume":"25","author":"RL Sacco","year":"1989","journal-title":"Ann Neurol"},{"key":"pone.0242885.ref002","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1161\/01.STR.14.1.110","article-title":"Cerebral infarction in young adults: a practical approach","volume":"14","author":"RG Hart","year":"1983","journal-title":"Stroke"},{"key":"pone.0242885.ref003","unstructured":"Statistics ABo. 3303.0\u2014Causes of Death, Australia, 2015. 2017 September 26. https:\/\/www.abs.gov.au\/ausstats\/abs@.nsf\/Lookup\/by%20Subject\/3303.0~2015~Main%20Features~Australia\u2019s%20leading%20causes%20of%20death,%202015~3"},{"key":"pone.0242885.ref004","first-page":"74","article-title":"Evaluation of patent foramen ovale in young adults with cryptogenic stroke","volume":"7","author":"HA Ebrahimi","year":"2011","journal-title":"ARYA Atherosclerosis"},{"key":"pone.0242885.ref005","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1161\/STROKEAHA.109.547828","article-title":"Patent foramen ovale in cryptogenic stroke: incidental or pathogenic?","volume":"40","author":"AA Alsheikh-Ali","year":"2009","journal-title":"Stroke"},{"key":"pone.0242885.ref006","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S1474-4422(18)30167-4","article-title":"Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis","volume":"17","author":"S Mazzucco","year":"2018","journal-title":"Lancet Neurol"},{"key":"pone.0242885.ref007","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1056\/NEJM198805053181802","article-title":"Prevalence of patent foramen ovale in patients with stroke","volume":"318","author":"P Lechat","year":"1988","journal-title":"N Engl J Med"},{"key":"pone.0242885.ref008","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1002\/ana.410130315","article-title":"Cerebral emboli of paradoxical origin","volume":"13","author":"HR Jones","year":"1983","journal-title":"Ann Neurol"},{"key":"pone.0242885.ref009","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1056\/NEJMoa1009639","article-title":"Closure or medical therapy for cryptogenic stroke with patent foramen ovale","volume":"366","author":"AJ Furlan","year":"2012","journal-title":"N Engl J Med"},{"key":"pone.0242885.ref010","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1056\/NEJMoa1301440","article-title":"Closure of patent foramen ovale versus medical therapy after cryptogenic stroke","volume":"368","author":"JD Carroll","year":"2013","journal-title":"N Engl J Med"},{"key":"pone.0242885.ref011","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1056\/NEJMoa1211716","article-title":"Percutaneous closure of patent foramen ovale in cryptogenic embolism","volume":"368","author":"B Meier","year":"2013","journal-title":"N Engl J Med"},{"key":"pone.0242885.ref012","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1056\/NEJMoa1707404","article-title":"Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke","volume":"377","author":"L Sondergaard","year":"2017","journal-title":"N Engl J 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Lee","year":"1991","journal-title":"Stroke"},{"key":"pone.0242885.ref026","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/0735-1097(91)90705-E","article-title":"Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology","volume":"17","author":"AC Pearson","year":"1991","journal-title":"J Am Coll Cardiol"},{"key":"pone.0242885.ref027","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.jacc.2015.12.023","article-title":"Device Closure of Patent Foramen Ovale After Stroke: Pooled Analysis of Completed Randomized Trials","volume":"67","author":"DM Kent","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"pone.0242885.ref028","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1177\/0003319718802635","article-title":"Patent Foramen Ovale Closure Versus Medical Therapy in Cryptogenic Strokes and Transient Ischemic Attacks: A Meta-Analysis of Randomized 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