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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
10:52

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Published on: December 23, 2022

Patent foramen ovale and cryptogenic stroke. A critical review

Luigi Ballerini1, Alberta Cifarelli, Antonio Ammirati

  • 1Department of Pediatric Cardiology, Bambino Gesù Hospital, Rome, Italy. ballerini.cifarelli@iol.it

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|January 27, 2007
PubMed

Insights

Patent foramen ovale (PFO) is common in cryptogenic stroke patients. Percutaneous PFO closure is considered for specific cases, showing promise in pediatric stroke prevention.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Cryptogenic stroke in young patients often lacks identifiable causes.
  • Patent foramen ovale (PFO) is found in 45% of cryptogenic stroke patients, compared to 25% in healthy individuals.
  • Right-to-left shunts through PFO are a suspected mechanism for ischemic cerebral events, potentially via paradoxical embolism.

Purpose of the Study:

  • To review the current understanding and indications for percutaneous closure of PFO in cryptogenic stroke.
  • To evaluate the safety and efficacy of PFO closure, particularly in specific patient subgroups.

Main Methods:

  • Review of existing literature and clinical data on PFO prevalence and its association with stroke.
  • Discussion of percutaneous closure techniques and current evidence, including ongoing randomized trials.
  • Analysis of outcomes in pediatric populations and specific indications like recurrent paradoxical embolism.

Main Results:

  • Percutaneous PFO closure is currently indicated for recurrent paradoxical embolism in patients with atrial septal aneurysm.
  • The procedure is considered safe and effective in preventing recurrent stroke in the pediatric population.
  • While debated for general cryptogenic stroke, ongoing trials are expected to provide further data.

Conclusions:

  • Percutaneous PFO closure is a viable option for specific indications, with growing evidence supporting its use in pediatric stroke.
  • The decreasing complication rates of device implantation may lower the threshold for considering PFO closure in broader patient groups.
  • Further data from randomized trials are crucial for defining the role of PFO closure in adult cryptogenic stroke management.

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