Uncovering the Risks and Benefits of Patent Foramen Ovale (PFO) Closure in Cryptogenic Stroke: A Case Study

Patent foramen ovale (PFO) exists in 20-25% of the adult population, and about 40% of adults who present with cryptogenic stroke (CS) have a PFO. The benefit of intervention has been debated with regard to stroke prevention given the high risk of postoperative atrial fibrillation (AF). In light of this, clinical decision-making is guided by PFO-Associated Stroke Causal Likelihood (PASCAL) classification and Risk of Paradoxical Embolism (RoPE) score analysis. Contemporary studies have shown superlative benefits of PFO with device closure and antiplatelet therapy. In our case study, we describe a 52-year-old female with no comorbid conditions who initially presented with expressive aphasia. Upon further diagnostic workup, she was found to have a PFO on transesophageal echocardiogram (TEE). Cardiac monitoring revealed no underlying arrhythmias. The patient subsequently underwent successful PFO repair with device-assisted closure and intracardiac monitor placement. She was discharged with dual antiplatelet therapy. On postoperative follow-up, no detected arrhythmias were revealed, and she made a meaningful recovery with near-total resolution of her symptoms. Our case raises the question of the extent of comprehensive evaluation to rule out underlying etiologies including AF prior to considering device-assisted closure and suggests the need for further studies.