To determine the significance of patent foramen ovale (PFO) in childhood stroke, we compared PFO prevalence, PFO features, and stroke recurrence risk in 25 children with cryptogenic arterial ischemic stroke (AIS), 54 children with AIS from a known etiology, and 209 healthy controls.

We performed a case-control analysis of a 14-year prospectively enrolled single-center cohort of children with AIS who underwent transthoracic echocardiogram (TTE) and compared them to TTEs of otherwise healthy children evaluated for benign cardiac concerns. Stroke patients 29 days to 18 years of age at stroke ictus with confirmed acute AIS on imaging, availability of complete diagnostic studies of stroke risk factors, including TTE images available for central review, and at least 1 follow-up evaluation after index stroke were included. Presence of PFO and high-risk PFO features were assessed by 2 independent, blinded reviewers and compared between groups with the Fisher exact test. Stroke/TIA recurrence risk was determined from Cox proportional hazards models.

Of 154 children with first-ever AIS, 79 were eligible; 25 had cryptogenic AIS, and 54 had a known cause. PFO prevalence was higher in the cryptogenic group (7, 28%) compared to both the known stroke etiology group (3, 5.6%, p = 0.009) and controls without stroke (24, 11.5%, p = 0.03). There were no significant differences in presence of right-to-left shunt and atrial septal aneurysm. Median follow-up time for entire stroke cohort was 20.9 months. Stroke-free recurrence at 2-years did not differ between children with and without PFO (HR 2.0, 95% CI 0.4–9.3, p = 0.39).

PFO prevalence was higher in children with cryptogenic stroke compared to patients with AIS with known etiology and healthy controls. PFO was not associated with increased recurrence risk. Optimal secondary preventive treatment in children with cryptogenic stroke and PFO remains uncertain and requires further study.

This study provides Class III evidence that children with cryptogenic ischemic stroke have an increased frequency of PFO compared to children with ischemic stroke of known etiology and healthy controls.

为了确定卵圆孔未闭 (PFO) 在儿童卒中中的重要性，我们比较了 25 名隐源性动脉缺血性卒中 (AIS) 儿童、54 名已知病因的 AIS 儿童和 209 名儿童的 PFO 患病率、PFO 特征和卒中复发风险。健康的对照。

我们对接受经胸超声心动图 (TTE) 的 14 年前瞻性单中心 AIS 儿童队列进行病例对照分析，并将其与其他健康儿童的 TTE 进行比较，以评估良性心脏问题。包括 29 天至 18 岁的卒中患者，影像学证实为急性 AIS，可获得卒中危险因素的完整诊断研究，包括可用于中央审查的 TTE 图像，以及至少 1 次卒中后的随访评估. PFO 和高风险 PFO 特征的存在由 2 位独立的盲审者评估，并通过 Fisher 精确检验在组间进行比较。中风/TIA 复发风险由 Cox 比例风险模型确定。

在 154 名首次患有 AIS 的儿童中，有 79 名符合条件；25 人患有隐源性 AIS，54 人有已知原因。与已知卒中病因组 (3, 5.6%, p = 0.009) 和无卒中对照组 (24, 11.5%, p = 0.03)相比，隐源性组 (7, 28%) 的 PFO 患病率更高。右向左分流和房间隔动脉瘤的存在没有显着差异。整个卒中队列的中位随访时间为 20.9 个月。有和没有 PFO 的儿童 2 年无卒中复发没有差异（HR 2.0，95% CI 0.4-9.3，p = 0.39）。

与已知病因和健康对照的 AIS 患者相比，隐源性卒中儿童的 PFO 患病率更高。PFO 与复发风险增加无关。隐源性卒中和 PFO 儿童的最佳二级预防治疗仍不确定，需要进一步研究。

该研究提供了 III 类证据，表明与已知病因和健康对照的缺血性中风儿童相比，隐源性缺血性中风儿童的 PFO 频率增加。