Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 916-921
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.916
Clinical relevance of atrial septal aneurysm and patent foramen ovale with migraine
Lu He, Ge-Sheng Cheng, Ya-Juan Du, Yu-Shun Zhang
Lu He, Ge-Sheng Cheng, Ya-Juan Du, Yu-Shun Zhang, Department of Structural Heart Disease, Xi’an Jiaotong University Medical College First Affiliated Hospital, Xi’an 710061, Shaanxi Province, China
Author contributions: He L and Zhang YS contributed to conceptualizing and designing the paper; Cheng GS and Du YJ contributed to data analysis and interpretation; He L drafted the article; Cheng GS contributed to critical revision of the article; all authors approved the article.
Institutional review board statement: The study was approved by the ethics committee of Xi’an Jiaotong University Medical College First Affiliated Hospital (Xi’an, China).
Clinical trial registration statement: The clinical trial is registered in ClinicalTrials.gov, using identifier NCT02777359. Details can be found at https://clinicaltrials.gov/ct2/show/NCT02777359?term=NCT02777359&rank=1.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Shun Zhang, MD, PhD, Doctor, Department of Structural Heart Disease, Xi’an Jiaotong University Medical College First Affiliated Hospital, 277 Yanta West Road, Xi’an 710061, Shaanxi Province, China. zys2889@sina.com
Telephone: +86-29-85324078 Fax: +86-29-85324078
Received: July 24, 2018
Peer-review started: July 24, 2018
First decision: October 8, 2018
Revised: October 14, 2018
Accepted: November 7, 2018
Article in press: November 7, 2018
Published online: December 6, 2018
Abstract
AIM

To test the potential association between atrial septal aneurysm (ASA) and migraine in patent foramen ovale (PFO) closure patients through an observational, single-center, case-controlled study.

METHODS

We studied a total of 450 migraineurs who had right-to-left shunts and underwent PFO closure in a retrospective single-center non-randomized registry from February 2012 to October 2016 on the condition that they were aged 18-45 years old. Migraine was diagnosed according to the International Classification of Headache Disorders, 3rd edition and evaluated using the Headache Impact Test-6 (HIT-6). All patients underwent preoperative transesophageal echocardiography, contrast transthoracic echocardiography, and computed tomography or magnetic resonance imaging examinations, with subsequent fluoroscopy-guided PFO closure. Based on whether they have ASA or not, the patients were divided into two groups: A (PFO with ASA, n = 80) and B (PFO without ASA, n = 370). Baseline characteristics and procedural and follow-up data were reviewed.

RESULTS

Compared to group B, group A had an increased frequency of ischemic lesions (11.3% vs 6.2%, P = 0.038) and migraine with aura (32.5% vs 21.1%, P = 0.040). The PFO size was significantly larger in group A (P = 0.007). There was no significant difference in HIT-6 scores between the two groups before and at the one-year follow-up after the PFO closure [61 (9) vs 63 (9), P = 0.227; 36 (13) vs 36 (10), P = 0.706].

CONCLUSION

Despite its small sample size, our study suggests that the prevalence of ASA in PFO with migraine patients is associated with ischemic stroke, larger PFO size, and migraine with aura.

Keywords: Patent foramen ovale, Migraine, Atrial septal aneurysm, Contrast transthoracic echocardiography, Right-to-left shunt, Transesophageal echocardiography

Core tip: The aim of this study was to test the potential association between atrial septal aneurysm (ASA) and migraine in patent foramen ovale (PFO) closure patients. A total of 450 migraineurs who had right-to-left shunts and underwent PFO closure on the condition that they were aged 18-45 years old were observed. Compared to the PFO without ASA patients, the PFO with ASA patients had an increased frequency of ischemic lesions and migraine with aura. The PFO size was significantly larger in PFO with ASA patients. There was no significant difference in Headache Impact Test-6 scores between the two groups before and at the one-year follow-up after the procedure.