Transcatheter PFO closure in an aircrew member with cryptogenic stroke: aeromedical disposition

Stroke is an uncommon event among military aircrew, partly because that population tends to be younger and healthier than typical stroke victims. Aircrew members suffering stroke rarely have identifiable risk factors or etiology that can be treated or modified such that return to flying duties is a consideration. In this case, an aircrew member was found to have a patent foramen ovale (PFO) during his stroke evaluation. Several studies support the association between PFO and cryptogenic stroke, but literature clearly defining the need for PFO repair in the context of cryptogenic stroke is still incomplete. On clinical recommendation from his providers, this aircrew member underwent elective closure of his PFO with a transcatheter device. After complete recovery from his stroke and an apparently successful PFO closure, he requested return to flying duties. History of stroke and PFO closure with transcatheter device were both disqualifying conditions according to United States Air Force Instructions. This case is presented as an example of an aeromedical decision-making process when confronted with an unusual case such as this.