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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 atrial septal aneurysm in cryptogenic stroke

Sujoy Ghosh1, Arjun Kumar Ghosh, Sandip Kumar Ghosh

  • 1Ayr Hospital, Dalmellington Road, Ayr, Ayrshire, UK.

Postgraduate Medical Journal
|March 9, 2007
PubMed

Insights

Cryptogenic strokes in young adults often involve a patent foramen ovale (PFO). While antiplatelet agents or warfarin are common treatments, PFO closure is reserved for specific cases due to inconclusive evidence on stroke prevention.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Cryptogenic strokes account for up to 40% of ischemic strokes in young adults.
  • Patent foramen ovale (PFO) is identified in over half of these patients, often with an atrial septal aneurysm.
  • Echocardiography, particularly transesophageal echocardiography, is the primary diagnostic tool.

Purpose of the Study:

  • To review the diagnostic approaches and management strategies for cryptogenic strokes in young adults.
  • To evaluate the role of patent foramen ovale (PFO) in stroke etiology and recurrence.
  • To discuss the current evidence regarding PFO closure versus medical therapy for stroke prevention.

Main Methods:

  • Literature review of studies investigating cryptogenic stroke, PFO, and atrial septal aneurysm.
  • Analysis of diagnostic methods, including echocardiography.
  • Examination of treatment outcomes for antiplatelet agents, warfarin, and percutaneous PFO closure.

Main Results:

  • Patent foramen ovale (PFO) is a frequent finding in cryptogenic strokes among young individuals.
  • Low-risk patients are typically managed with antiplatelet agents, while high-risk patients receive warfarin.
  • Data on the efficacy of PFO closure for preventing recurrent stroke remain inconclusive.

Conclusions:

  • Patent foramen ovale (PFO) is a significant consideration in the workup of cryptogenic strokes in young adults.
  • Medical therapy (antiplatelets or warfarin) is the standard initial treatment based on risk stratification.
  • Percutaneous PFO closure is considered for recurrent stroke or medical therapy intolerance, despite limited evidence of its preventative efficacy.

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