Central retinal artery occlusion associated with patent foramen ovale: a case report and literature review

ABSTRACT Patent foramen ovale might cause cryptogenic strokes, including retinal artery occlusion. Herein, we describe a previously healthy young man who presented with central retinal artery occlusion in the setting of patent foramen ovale and explore the need for transesophageal echocardiogram for its diagnosis. Cardiovascular workup and neuroimaging were unremarkable. Transthoracic echocardiogram bubble study revealed a right to left atrial shunt and subsequent transesophageal echocardiogram disclosed patent foramen ovale. This congenital cardiac anomaly was the likely conduit for a thrombo-embolic central retinal artery occlusion. We identified seven patients with patent foramen ovale associated with central retinal artery occlusion in the literature. Transthoracic echocardiogram was diagnostic in only one patient (14.3%), whereas transesophageal echocardiogram was required to reveal patent foramen ovale in the remaining six (85.7%). Our case and the previous reports support the link between central retinal artery occlusion and patent foramen ovale. Therefore, providers should consider the more sensitive transesophageal echocardiogram during the initial evaluation of young patients without immediately identifiable causes of retinal artery occlusion.

卵圆孔未闭（patent foramen ovale）可能引发包括视网膜动脉阻塞（retinal artery occlusion）在内的隐源性卒中（cryptogenic strokes）。本文报道1例既往体健的年轻男性患者，该患者因合并卵圆孔未闭而出现视网膜中央动脉阻塞（central retinal artery occlusion），并探讨该病诊断中行经食管超声心动图（transesophageal echocardiogram）的必要性。患者心血管系统全面排查及神经影像学检查均未见异常。经胸超声心动图（transthoracic echocardiogram）气泡试验显示存在右向左心房分流，后续行经食管超声心动图确诊卵圆孔未闭。该先天性心脏异常为血栓栓塞性视网膜中央动脉阻塞的潜在分流通道。经文献检索，共纳入7例卵圆孔未闭合并视网膜中央动脉阻塞的病例。其中仅1例（14.3%）经经胸超声心动图确诊，剩余6例（85.7%）均需行经食管超声心动图方可明确卵圆孔未闭诊断。本病例及既往文献报道均证实视网膜中央动脉阻塞与卵圆孔未闭之间存在显著关联。因此，对于无明确诱因的年轻视网膜动脉阻塞患者，临床医师在初始评估阶段应优先选用灵敏度更高的经食管超声心动图检查。