Systemic allergic reaction to the percutaneous patent foramen ovale occluder.

ciation between the descending aorta and APOE*E4. Potential reasons for this include the fact that the progression of atherosclerosis in the aorta is influenced by the flow dynamics and wall shear stress within the segments of the aorta.4 For example, the higher ejection velocity in the ascending aorta might limit formation of plaques in this region. More importantly, the influence of age on atherosclerosis is very strong, with an incidence rising steadily with age.5 Because patients undergoing cardiac surgery are increasingly elderly, the effect of APOE*E4 might be masked by the dominating influence of age on atherosclerosis, particularly in the descending aorta. Limitations to our study include the fact that our technique uses a 2-dimensional, rather than 3-dimensional, image of a specific aortic segment. Nevertheless, the percentage of atheroma method that we used does at least account for total plaque area that can be visualized. Finally, epiaortic imaging is a more sensitive measure of assessing plaque in the ascending aorta, and it is possible that a greater degree of atherosclerosis might have been detected, with its use potentially improving the link between atheroma burden and the APOE*E4 allele.