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Background Despite the fact that stroke is a leading cause of disability, in up to 40% of cases no cause is found on routine clinical investigation. Although a patent foramen ovale (PFO) is an attractive mechanism to explain these cryptogenic strokes, using current imaging techniques, distinguishing between a causative rather than an incidental PFO remains elusive. We hypothesised that, in the presence of a PFO, non-vortical right atrial (RA) flow patterns would be linked to embolism risk by making it more likely to shunt blood, and as such thrombus through the PFO. In order to investigate this we assessed RA flow patterns and interatrial shunt size in patients with a PFO and investigated whether these metrics predicted the incidence of paradoxical embolism.

In the presence of a patent foramen ovale paroxysmal embolism risk increases with non-vortical right atrial blood flow