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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

Multidisciplinary management of patent foramen ovale (PFO) and cryptogenic stroke/TIA

Naqibullah Mirzada1, Per Ladenvall, Per-Olof Hansson

  • 1GUCH Centre, Sahlgrenska University Hospital/Östra, Gothenburg, SwedenDept of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden.

Journal of Multidisciplinary Healthcare
|October 2, 2013
PubMed

Insights

A multidisciplinary PFO conference and clinical algorithm for patent foramen ovale (PFO) closure in cryptogenic stroke (CS) patients resulted in a 46% closure rate. This rigorous process ensured appropriate treatment, avoiding both overtreatment and undertreatment.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Diagnostics

Background:

  • Patent foramen ovale (PFO) is a potential risk factor for cryptogenic ischemic stroke (CS).
  • Established indications for PFO closure remain debated, leading to inconsistent patient selection.
  • A standardized approach is needed to guide decisions on PFO closure versus conservative management.

Purpose of the Study:

  • To describe the implementation of a multidisciplinary PFO conference and a formalized clinical algorithm for PFO closure decisions.
  • To evaluate the impact of this process on the rate of PFO closures and patient re-referrals.
  • To ensure objective decision-making, avoiding personal preferences and economic influences.

Main Methods:

  • A multidisciplinary team (neurology, cardiology, internal medicine, thromboembolism, echocardiography) reviewed 311 patient cases from 2006-2009.
  • Key closure criteria included first-ever CS with PFO and atrial septal aneurysm, or recurrent CS with PFO without aneurysm.
  • A formalized clinical algorithm guided the closure versus no closure decision-making process.

Main Results:

  • Out of 311 patients, 143 (46%) were accepted for PFO closure, while 167 (54%) were rejected.
  • Patients accepted for closure were significantly younger (mean 50 years vs. 58 years).
  • Only 1.8% of initially rejected patients were re-referred due to recurrent stroke, with subsequent closure performed.

Conclusions:

  • The study highlights the complexity of the PFO-CS relationship, with an acceptance rate below 50%.
  • A rigorous, multidisciplinary approach is crucial to balance overtreatment and undertreatment in PFO closure decisions.
  • The developed algorithm demonstrated a stable closure acceptance rate and a low rate of repeat referrals, indicating effective patient selection.
Abstract

Keywords:
clinical algorithmcryptogenic strokepatent foramen ovalepatent foramen ovale closure

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