Valvular & structural heart diseaseResearch article
Funnel-type patent foramen ovale morphology on 3D echocardiography: a novel high-risk anatomic feature
- morphological classification of patent foramen ovale (PFO) using 3D transoesophageal echocardiography (TEE)
- consecutive patients
Authors' conclusion
Prior events are highly correlated with funnel-type PFO, particularly when RA opening area exceeds 15.85 mm2. This geometry may act as an embolic ‘catchment’ and favour in situ thrombosis due to disturbed flow from the wide RA inlet to the narrow tunnel exit. Integration of 3D-TEE morphology with systemic risk factors such as smoking and dyslipidaemia may refine patient stratification and guide management.
Study context
- Population
- Consecutive patients with a right-to-left shunt undergoing 3D-TEEThirty-seven (38.9%) had prior events
- Participants
- 95 patients
- Comparison
- Morphology was related to the clinical history of ischaemic stroke or transient ischaemic attack (events)
- event groupn = Thirty-seven
Main finding
As reported in the abstract
Cross-sectional area of the RA opening
P = 0.002
Further findings
| Outcome | event group | cone type | funnel type | P value |
|---|---|---|---|---|
| Funnel morphology prevalence · more common in the event group | 81.1% | Not reported in the abstract | Not reported in the abstract | P = 0.001 |
| Rate of events · more than twice the rate of events with funnel | Not reported in the abstract | 19.4% | 50.8% | P = 0.002 |
- Funnel morphology prevalence: no events 50%
Independent predictors of events (multivariable analysis)
- dyslipidaemia OR
- 21.06
- smoking OR
- 6.25
- funnel morphology OR
- 6.47
- larger RA opening area OR per mm²
- 1.026
- comparator groups for ORs not printed
ROC analysis of RA opening area to predict events
- optimal cut-off RA opening area
- >15.85 mm²
- area under the curve
- 0.719
Original publication
Funnel-type patent foramen ovale morphology on 3D echocardiography: a novel high-risk anatomic feature. Eur Heart J Cardiovasc Imaging. Published 31 March 2026. doi:10.1093/ehjci/jeag089
Summarised from the published abstract; every number is checked against it