{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:07:06Z","timestamp":1785409626097,"version":"3.56.0"},"reference-count":44,"publisher":"IMR Press","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003819","name":"Hubei Provincial Natural Science Foundation","doi-asserted-by":"crossref","award":["2025AFD873"],"award-info":[{"award-number":["2025AFD873"]}],"id":[{"id":"10.13039\/501100003819","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Medical Science and Technology Innovation Platform Support Project of Zhongnan Hospital of Wuhan University","award":["PTXM2025026"],"award-info":[{"award-number":["PTXM2025026"]}]},{"name":"Science and Technology Innovation Cultivation Fund of Zhongnan Hospital of Wuhan University","award":["CXPY2024076"],"award-info":[{"award-number":["CXPY2024076"]}]},{"name":"Hubei Province Key research and development projects","award":["2025BCB019"],"award-info":[{"award-number":["2025BCB019"]}]},{"name":"Wuhan University Zhongnan Hospital Science and Technology Achievement Transformation Fund Clinical Research and Development Fund","award":["LCYFMS2023008"],"award-info":[{"award-number":["LCYFMS2023008"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background:Patent foramen ovale (PFO) is a crucial etiology of cryptogenic stroke, with paradoxical embolism recognized as its classic pathogenic mechanism. However, the origin of most emboli remains unclear. This study aimed to detect the presence and location of in situ thrombus on the interatrial septum in patients with PFO using contrast-enhanced transesophageal echocardiography (c-TEE) and analyze its correlation with stroke and migraine, thereby providing novel insights into the pathogenesis of PFO-related diseases.Methods:A retrospective analysis was performed on 3343 patients who underwent TEE examination between March 2021 and December 2024. Patients were divided into the in situ thrombus group (n = 62) and the non-in situ thrombus group (n = 1211) based on TEE findings. According to clinical symptoms, patients were categorized into the stroke group (n = 210), the migraine group (n = 633), and the asymptomatic group (n = 430). TEE was used to comprehensively assess the location, size, and quantity of the in situ thrombus. The anatomical parameters and hemodynamic parameters of PFO were compared among different groups.Results:Among 1273 PFO patients, the overall detection rate of in situ thrombus on the interatrial septum by TEE was 4.56% (62\/1273). The detection rate of in situ thrombus in the stroke group (11.90%, 25\/210) was significantly higher than that in the migraine group (2.53%, 16\/633) and the asymptomatic group (3.95%, 17\/430) (p &lt; 0.001). In situ thrombus was most commonly located on the right atrial surface of the interatrial septum (69.0%, 40\/62). The PFO diameter in the thrombus group was significantly larger than that in the non-thrombus group (p = 0.0033), and the shunt velocity was also significantly higher (p &lt; 0.001). At the same time, no significant difference in PFO length was observed between the two groups. All patients with a detected in situ thrombus had negative findings on lower-extremity venous ultrasonography. After PFO closure, the rate of symptom improvement in the stroke group was significantly higher than in the migraine group (95.68% vs 52.80%, p &lt; 0.005).Conclusions:c-TEE is an effective method for detecting in-situ thrombus in the atrial septum in patients with PFO, and such thrombus may play an important role in PFO-related stroke. PFO closure may be effective in stroke patients with concomitant in-situ thrombus. In clinical practice, routine risk stratification should be performed in patients with PFO, with an emphasis on identifying high-risk features and in situ thrombus lesions, to provide a basis for individualized treatment decisions.<\/jats:p>","DOI":"10.31083\/rcm50472","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:31:43Z","timestamp":1785407503000},"source":"Crossref","is-referenced-by-count":0,"title":["Correlation Between Interatrial Septal In Situ Thrombus and Stroke Evaluated by Transesophageal Echocardiography"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0201-9154","authenticated-orcid":true,"given":"Bin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Jinan University, 510627 Guangzhou, Guangdong, China"},{"name":"Department of Cardiovascular Ultrasound, Zhongnan Hospital of Wuhan University, 430071 Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8148-7152","authenticated-orcid":true,"given":"Shuang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Ultrasound, Zhongnan Hospital of Wuhan University, 430071 Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4425-1405","authenticated-orcid":true,"given":"Minxin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Ultrasound, Zhongnan Hospital of Wuhan University, 430071 Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5098-6376","authenticated-orcid":true,"given":"Kehan","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Ultrasound, Zhongnan Hospital of Wuhan University, 430071 Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7377-382X","authenticated-orcid":true,"given":"Shuixing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Jinan University, 510627 Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clinic Proceedings. 1984; 59: 17\u201320.","DOI":"10.1016\/s0025-6196(12)60336-x"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Meier B, Lock JE. Contemporary management of patent foramen ovale. Circulation. 2003; 107: 5\u20139.","DOI":"10.1161\/01.cir.0000046073.34261.c1"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Mojadidi MK, Zaman MO, Elgendy IY, Mahmoud AN, Patel NK, Agarwal N, et al. Cryptogenic Stroke and Patent Foramen Ovale. Journal of the American College of Cardiology. 2018; 71: 1035\u20131043.","DOI":"10.1016\/j.jacc.2017.12.059"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Pristipino C, Sievert H, D'Ascenzo F, Louis Mas J, Meier B, Scacciatella P, et al. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. European Heart Journal. 2019; 40: 3182\u20133195.","DOI":"10.1093\/eurheartj\/ehy649"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Elgendy AY, Saver JL, Amin Z, Boudoulas KD, Carroll JD, Elgendy IY, et al. Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale-Associated Stroke. JAMA Neurology. 2020; 77: 878\u2013886.","DOI":"10.1001\/jamaneurol.2020.0458"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP, PFO in Cryptogenic Stroke Study (PICSS) Investigators. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation. 2002; 105: 2625\u20132631.","DOI":"10.1161\/01.cir.0000017498.88393.44"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, et al. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. The New England Journal of Medicine. 2017; 377: 1011\u20131021.","DOI":"10.1056\/NEJMoa1705915"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Hart RG, Sharma M, Mundl H, Kasner SE, Bangdiwala SI, Berkowitz SD, et al. Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source. The New England Journal of Medicine. 2018; 378: 2191\u20132201.","DOI":"10.1056\/NEJMoa1802686"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Spencer BT, Qureshi Y, Sommer RJ. A retrospective review of clopidogrel as primary therapy for migraineurs with right to left shunt lesions. Cephalalgia : an International Journal of Headache. 2014; 34: 933\u2013937.","DOI":"10.1177\/0333102414523845"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Reisman AM, Robbins BT, Chou DE, Yugrakh MS, Gross GJ, Privitera L, et al. Ticagrelor for Refractory Migraine\/Patent Foramen Ovale (TRACTOR): An open-label pilot study. Neurology. 2018; 91: 1010\u20131017.","DOI":"10.1212\/WNL.0000000000006573"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Sommer RJ, Nazif T, Privitera L, Robbins BT. Retrospective review of thienopyridine therapy in migraineurs with patent foramen ovale. Neurology. 2018; 91: 1002\u20131009.","DOI":"10.1212\/WNL.0000000000006572"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Wilmshurst PT, Nightingale S, Walsh KP, Morrison WL. Effect on migraine of closure of cardiac right-to-left shunts to prevent recurrence of decompression illness or stroke or for haemodynamic reasons. Lancet. 2000; 356: 1648\u20131651.","DOI":"10.1016\/S0140-6736(00)03160-3"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. 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Diagnostic yield of pelvic magnetic resonance venography in patients with cryptogenic stroke and patent foramen ovale. Stroke. 2014; 45: 2324\u20132329.","DOI":"10.1161\/STROKEAHA.114.005539"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Lapergue B, Decroix JP, Evrard S, Wang A, Bendetowicz D, Offroy MA, et al. Diagnostic Yield of Venous Thrombosis and Pulmonary Embolism by Combined CT Venography and Pulmonary Angiography in Patients with Cryptogenic Stroke and Patent Foramen Ovale. European Neurology. 2015; 74: 69\u201372.","DOI":"10.1159\/000437261"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Osgood M, Budman E, Carandang R, Goddeau RP, Henninger N. Prevalence of Pelvic Vein Pathology in Patients with Cryptogenic Stroke and Patent Foramen Ovale Undergoing MRV Pelvis. 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Stroke. 2023; 54: 1205\u20131213.","DOI":"10.1161\/STROKEAHA.122.041524"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Ren W, Huang H, Hu H. Optical coherence tomography imaging evidence of thrombus inside the tunnel of Patent Foramen Ovale. European Heart Journal. 2022; 43: 3982.","DOI":"10.1093\/eurheartj\/ehac465"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Leventis IA, Sagris D, Strambo D, Perlepe K, Sirimarco G, Nannoni S, et al. Atrial Cardiopathy and Likely Pathogenic Patent Foramen Ovale in Embolic Stroke of Undetermined Source. Thrombosis and Haemostasis. 2021; 121: 361\u2013365.","DOI":"10.1055\/s-0040-1715831"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Sardana M, Lessard D, Tsao CW, Parikh NI, Barton BA, Nah G, et al. Association of Left Atrial Function Index with Atrial Fibrillation and Cardiovascular Disease: The Framingham Offspring Study. Journal of the American Heart Association. 2018; 7: e008435.","DOI":"10.1161\/JAHA.117.008435"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Rigatelli G, Zuin M, Adami A, Aggio S, Lanza D, d'Elia K, et al. Left atrial enlargement as a maker of significant high-risk patent foramen ovale. The International Journal of Cardiovascular Imaging. 2019; 35: 2049\u20132056.","DOI":"10.1007\/s10554-019-01666-x"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Rigatelli G, Aggio S, Cardaioli P, Braggion G, Giordan M, Dell'avvocata F, et al. Left atrial dysfunction in patients with patent foramen ovale and atrial septal aneurysm: an alternative concurrent mechanism for arterial embolism? JACC. Cardiovascular Interventions. 2009; 2: 655\u2013662.","DOI":"10.1016\/j.jcin.2009.05.010"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Gwak SY, Kim K, Lee HJ, Cho I, Hong GR, Ha JW, et al. Three-dimensional agitated saline contrast transesophageal echocardiography for the diagnosis of patent foramen ovale. Scientific Reports. 2025; 15: 29136.","DOI":"10.1038\/s41598-025-14873-5"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Faletra FF, Agricola E, Flachskampf FA, Hahn R, Pepi M, Ajmone Marsan N, et al. Three-dimensional transoesophageal echocardiography: how to use and when to use-a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology. European Heart Journal. Cardiovascular Imaging. 2023; 24: e119\u2013e197.","DOI":"10.1093\/ehjci\/jead090"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, et al. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 2015; 28: 910\u2013958.","DOI":"10.1016\/j.echo.2015.05.015"},{"key":"ref35","unstructured":"Blum A, Reisner S, Farbstein Y. Transesophageal echocardiography (TEE) vs. transthoracic echocardiography (TTE) in assessing cardio-vascular sources of emboli in patients with acute ischemic stroke. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2004; 10: CR521\u20133."},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Shah S, Malik P, Patel U, Wang Y, Gronseth GS. Diagnostic Yield of TEE in Patients with Cryptogenic Stroke and TIA with Normal TTE: A Systematic Review and Meta-Analysis. Neurology International. 2021; 13: 659\u2013670.","DOI":"10.3390\/neurolint13040063"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Palazzo P, Heldner MR, Nasr N, Alexandrov AV. Transcranial Doppler With Microbubbles: Screening Test to Detect and Grade Right-to-Left Shunt After an Ischemic Stroke: A Literature Review. Stroke. 2024; 55: 2932\u20132941.","DOI":"10.1161\/STROKEAHA.124.046907"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Travis JA, Fuller SB, Ligush J, Plonk GW, Geary RL, Hansen KJ. Diagnosis and treatment of paradoxical embolus. Journal of Vascular Surgery. 2001; 34: 860\u2013865.","DOI":"10.1067\/mva.2001.118815"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Samuel S, Reddy ST, Parsha KN, Nguyen T, Reddy Indupuru HK, Sharrief AZ, et al. Routine surveillance of pelvic and lower extremity deep vein thrombosis in stroke patients with patent foramen ovale. Journal of Thrombosis and Thrombolysis. 2021; 51: 1150\u20131156.","DOI":"10.1007\/s11239-020-02262-w"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Caso V, Turc G, Abdul-Rahim AH, Castro P, Hussain S, Lal A, et al. European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke. European Stroke Journal. 2024; 9: 800\u2013834.","DOI":"10.1177\/23969873241247978"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Li W, Zhang J, Zhang Y, Shentu W, Yan S, Chen Q, et al. Clinical research progress on pathogenesis and treatment of Patent Foramen Ovale-associated stroke. Frontiers in Neurology. 2025; 16: 1512399.","DOI":"10.3389\/fneur.2025.1512399"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Wang S, Zhang M, Liu J, Wang B. Pulmonary Embolism With Serpentine Thrombus Straddling a Patent Foramen Ovale. JACC. Case Reports. 2025; 30: 104819.","DOI":"10.1016\/j.jaccas.2025.104819"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Rigatelli G. Patent foramen ovale: the evident paradox between the apparently simple treatment and the really complex pathophysiology. Journal of Cardiovascular Medicine (Hagerstown, Md.). 2007; 8: 300\u2013304.","DOI":"10.2459\/01.JCM.0000263497.99157.77"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Goel SS, Tuzcu EM, Shishehbor MH, de Oliveira EI, Borek PP, Krasuski RA, Rodriguez LL, et al. Morphology of the patent foramen ovale in asymptomatic versus symptomatic (stroke or transient ischemic attack) patients. 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