ABSTRACT NUMBER: ESOC2026A847 PATENT FORAMEN OVALE IS NOT ONLY A CAUSE OF STROKE: REPORT OF 2 CASES WITH MYOCARDIAL INFARCTION

Abstract Background and aims While a patent foramen ovale (PFO) is a well-recognized cause of ischemic stroke (IS) in young adults, its role in the occurrence of myocardial infarctions (MI) is less well established. Methods We report two patients with IS and MI with normal coronary arteries who were found to have a PFO. Results First patient: a woman in her late fifties presented with a right MCA stroke. Since her early forties, the patient has experienced two MIs without angiographically significant coronary lesions, one TIA and one ischemic stroke despite antiplatelet therapy. The etiologic work-up after this new stroke was negative except for a PFO with a massive right-to-left interatrial shunt. The Risk of Paradoxical Embolism (RoPE) score was 7, indicating probable causality according to the PFO-Associated Stroke Causal Likelihood (PASCAL) classification. Second patient: a woman in her mid-sixties experienced a posterior-inferior MI without angiographically significant coronary lesions, concurrent with a neurological episode due to a punctate IS. The etiologic work-up was negative except for a PFO with a massive right-to-left shunt and an interatrial septum aneurysm. Her RoPE score was 6, suggesting possible causality according to the PASCAL classification. Conclusions PFO is a rare (< 1 %) cause of MI and should be investigated in cases of unexplained MI. Secondary prevention of PFO-related MI is less consensual than it is for stroke in patients < 60 years. In our cases, PFO closure was decided after multidisciplinary team meeting because of associated ischemic strokes. Conflict of interest The authors have nothing to disclose.