ArticleJAMA2018
Association of Preoperatively Diagnosed Patent Foramen Ovale With Perioperative Ischemic Stroke.
Article in JAMA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Pooled it
- Diagnosis and Management of Patients with Patent Foramen Ovale: Current Evidence and Future Perspective.Journal of cardiovascular development and disease · 2026Review
- Patent foramen ovale, bone cement implantation syndrome and paradoxical embolism : Case study and pathophysiological aspects.Die Anaesthesiologie · 2026Article
- A Case of Sigmoid Colon Cancer with Patent Foramen Ovale and Left-Sided Inferior Vena Cava Initially Detected during the Workup for Cerebral Infarction.Surgical case reports · 2026Article
- Paradoxical embolism via patent foramen ovale induced by deep venous thrombosis and acute pulmonary embolism.Journal of vascular surgery cases and innovative techniques · 2025Article
- Postoperative Stroke Through a Patent Foramen Ovale in a Patient With Lung Cancer: A Case Report.Cureus · 2025Article
- The Association Between Aspartate Transaminase to Alanine Transaminase Ratio and Perioperative Ischemic Stroke in Patients With Diabetes: A Retrospective Cohort Study.CNS neuroscience & therapeutics · 2025Article
- Rapid-onset cerebral fat embolism syndrome leading to brain death: A case report.Trauma case reports · 2024Article
- Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery.Nature medicine · 2024Article
- An Automated Heart Shunt Recognition Pipeline Using Deep Neural Networks.Journal of imaging informatics in medicine · 2024Article
- Use of Transesophageal Echocardiography During Orthotopic Liver Transplantation: Simplifying the Procedure.Transplantation direct · 2024Review
- Perioperative stroke.Nature reviews. Disease primers · 2024Review
- Cerebral fat emboli in a patient with paraplegia caused by bilateral femur fractures.BMJ case reports · 2024Article
- Impact of patent foramen ovale on short-term outcomes in children with biliary atresia undergoing living donor liver transplantation: a retrospective cohort study.BMC anesthesiology · 2023Article
- Patent foramen Ovale-related paradoxical embolism after noncardiac surgery.Journal of cardiology cases · 2023Article
- Heart-brain axis: Association of congenital heart abnormality and brain diseases.Frontiers in cardiovascular medicine · 2023Review
- Risk factors and complications associated with intra-operative or post-operative identification of a PFO in cardiac surgery patients: A cohort study.Frontiers in neurology · 2022Article
- European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2021Article
- Effects of Volatile Anesthetics on Postoperative Ischemic Stroke Incidence.Journal of the American Heart Association · 2021Article
- Cerebral Large Vessel Occlusion Caused by Fat Embolism-A Case Series and Review of the Literature.Frontiers in neurology · 2021Article
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Perioperative stroke is a major complication for patients undergoing surgery. Patent foramen ovale (PFO) represents a possible anatomical link between venous thrombosis and stroke. Objective: To determine whether a preoperatively diagnosed PFO is associated with increased risk of perioperative ischemic stroke. Design, Setting, and Participants: Retrospective cohort study from Massachusetts General Hospital and 2 affiliated community hospitals between January 1, 2007, and December 31, 2015. Participants were 182 393 consecutive adults undergoing noncardiac surgery with general anesthesia. Exposures: Preoperatively diagnosed PFO. Main Outcomes and Measures: Perioperative ischemic stroke occurring within 30 days of surgery; stroke subtype by Oxfordshire Community Stroke Project classification and stroke severity by National Institute of Health Stroke Scale (NIHSS). Results: Among the 150 198 patient cases analyzed (median [SD] age, 55 [16] years), 1540 (1.0%) had a diagnosis of PFO before surgery. A total of 850 (0.6%) ischemic strokes occurred within 30 days of surgery (49 [3.2%] among patients with PFO and 801 [0.5%] among patients without PFO). In adjusted analyses, patients with PFO had an increased risk of ischemic stroke compared with patients without PFO (odds ratio, 2.66 [95% CI, 1.96-3.63]; P < .001). The estimated risks of stroke were 5.9 for every 1000 patients with PFO and 2.2 for every 1000 patients without PFO (adjusted absolute risk difference, 0.4% [95% CI, 0.2%-0.6%). Patients with PFO also had an increased risk of large vessel territory stroke (relative risk ratio, 3.14 [95% CI, 2.21-4.48]; P < .001) and a more severe stroke-related neurologic deficit measured by NIHSS (median, 4 [interquartile range {IQR}, 2-10] vs median, 3 [IQR, 1-6] for those without PFO; P = .02). Conclusions and Relevance: Among adult patients undergoing noncardiac surgery at 3 hospitals, having a preoperatively diagnosed PFO was significantly associated with increased risk of perioperative ischemic stroke within 30 days after surgery. Further research is needed to confirm these findings and to determine whether interventions would decrease this risk.
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