To the Editor: Dr Krasuski and colleagues1 investigated the association of intraoperative patent foramen ovale (PFO) closure with perioperative outcomes and long-term survival. The study found that the risk of perioperative stroke was not associated with closure of a PFO at the time of incidental intraoperative discovery. Technical advancement and the widespread use of intraoperative transesophageal echocardiography (TEE) have increased the incidence of diagnosing a PFO at the time of surgery and have raised questions about best possible management.2 - 3
The study population had several risk factors for developing a perioperative stroke, and both study groups had a high incidence of atheromatous disease of the aorta (71% in each group). The group receiving PFO closure had a larger number of patients undergoing isolated mitral or tricuspid valve procedures. Patients undergoing coronary artery bypass grafting surgery have a higher prevalence of atheromatous disease of the aorta compared with patients undergoing isolated valve procedures.4
Atheroma of the aorta is difficult to diagnose; manual palpation of the aorta is not a reliable technique to identify aortic atheroma and prevent the development of a stroke through carrying calcifications into the circulation during surgical cannulation.5 A systematic evaluation of the aorta with the help of intraoperative epiaortic echocardiography is necessary to diagnose the degree of aortic atheroma since TEE cannot reliably visualize the aortic arch at the site of surgical manipulation. Therefore, it would help to know the percentage of patients in each group who received intraoperative epiaortic echocardiography to identify the severity of atheromatous disease of the aorta.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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