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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: when is intervention warranted?

Michael J Landzberg1, Paul Khairy

  • 1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. mlandzberg@partners.org

The Canadian Journal of Cardiology
|June 25, 2013
PubMed

Insights

Patent foramen ovale (PFO) is common and often asymptomatic. Current evidence shows no benefit, and potential harm, from closing a PFO for stroke or migraine prevention.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Diagnostics

Background:

  • The foramen ovale is a normal fetal structure that often remains patent (open) in a significant percentage of the population into adulthood.
  • A patent foramen ovale (PFO) has been anecdotally linked to various pathologies, leading to interventions based on association rather than proven causality.
  • Understanding the clinical significance of a PFO requires differentiating common anatomical variants from pathological conditions.

Purpose of the Study:

  • To review the current best practices and evidence regarding the intervention on a patent foramen ovale (PFO).
  • To evaluate the efficacy and safety of PFO closure based on recent randomized controlled trials (RCTs) and clinical guidelines.
  • To provide a data-driven perspective on the decision-making process for altering the cardiovascular system by closing a PFO.

Main Methods:

  • Systematic review of recent randomized controlled trials (RCTs) focusing on PFO closure.
  • Analysis of current international practice guidelines for cardiovascular interventions.
  • Evaluation of clinical outcomes related to stroke, transient ischemic attack (TIA), and migraine in patients with PFO.

Main Results:

  • Current medical guidelines do not indicate PFO closure as a standard treatment, regardless of intervention method (transcatheter or surgical).
  • Recent RCTs have failed to demonstrate a significant reduction in stroke or TIA risk for PFO closure.
  • Intervention for PFO closure has shown increased adverse events without providing accrued benefits for stroke prevention or migraine elimination.

Conclusions:

  • Intervention for patent foramen ovale (PFO) is not currently recommended by medical guidelines.
  • Closing a PFO does not appear to reduce the risk of stroke or transient ischemic attack (TIA) and may increase harm.
  • The decision to intervene on a PFO should be based on robust data and evidence, not on commonness or assumed causality.

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