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Background and Purpose-Patent foramen ovale (PFO) is an established cause of stroke in young patients without other determined etiologies (ie, cryptogenic stroke). The additional presence of atrial septum aneurysm (ASA) possibly increases stroke risk, but it remains undetermined which factors best predict thromboembolism in patients with PFO. Diffusion-weighted imaging (DWI) may help to distinguish the characteristics of cerebral embolism associated with different features of the interatrial septum in PFO stroke. Methods-In a stroke databank-based cohort study, DWI and transthoracic/transesophageal echocardiography findings were assessed in 48 consecutive patients with cryptogenic ischemic stroke associated with PFO. The number, size, and distribution of acute ischemic lesions on DWI were correlated with PFO size, degree of interatrial right-to-left shunt (RLS), and the presence of ASA. Results-Patients with PFO plus ASA combined more often had multiple acute DWI lesions (16 of 30, 53%) than those with PFO alone (3 of 18, 17%; Pϭ0.01). This association remained significant after correction for PFO size, degree of RLS, and vascular risk factors in a logistic-regression analysis (Pϭ0.04). No significant associations between DWI lesion characteristics and PFO size or degree of RLS were found. Conclusions-The presence of concomitant ASA is independently associated with multiple cerebral ischemic lesions in PFO stroke, which may indicate an increased embolic risk.

The response of pulmonary artery pressure to high altitude has not been studied in children. It is also not known whether the individual response is hereditary. Therefore, the response of pulmonary artery pressure to high altitude was measured in pre-pubertal children in comparison to that in their biological fathers.Echocardiography was performed at 450 m and over 3 days at 3,450 m. Systolic pulmonary artery pressure was estimated from the pressure gradient of tricuspid regurgitation.The increase in pulmonary artery pressure in children was greater than that in adults at day 1 of high altitude (15.5¡9.1 versus 7.9¡6.4 mmHg), but returned to adult levels on day 2. The increase in pulmonary artery pressure from low to high altitude of each child correlated with that in the father.Pre-pubertal children transiently develop greater pulmonary hypertension than their fathers when exposed to high altitude. The individual response of pulmonary pressure to high altitude seems to be at least partly hereditary.

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Our results show the important role of LA volume for the long-term freedom from arrhythmia after AF ablation. These data also highlight the potential of 3-D echocardiography in this context and may facilitate patient selection for AF ablation.