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Updated: May 17, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Treatment of patent foramen ovale
Christian Pristipino1, John Carroll2, Jean-Louis Mas3
1Clinique Turin, Institut Cœur Paris Centre (ICPC), Paris, France.
Insights
Percutaneous closure of patent foramen ovale (PFO) is a primary stroke prevention in select patients. Further research is needed to refine indications and optimize post-procedure care for PFO closure.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Patent foramen ovale (PFO) closure is debated for primary stroke prevention.
- Established as first-line for secondary prevention in patients aged 18-60.
- Considered for specific cases beyond age limits and other indications like deoxygenation syndromes.
Purpose of the Study:
- To review the current status of percutaneous PFO closure.
- To discuss indications, diagnostic work-up, and procedural aspects.
- To highlight areas needing further research.
Main Methods:
- Review of established percutaneous closure techniques for PFO.
- Discussion of device selection and post-procedure management.
- Analysis of diagnostic work-up and potential complications.
Main Results:
- Percutaneous PFO closure is standardized with double-disc occluders, showing efficacy and safety.
- Procedure is generally straightforward but can be challenging with specific anatomies.
- Early and late complications are infrequent but require prompt diagnosis.
Conclusions:
- PFO closure is a key secondary stroke prevention strategy in specific patient groups.
- Further evidence is required to improve diagnosis, expand indications, and optimize treatment.
- Collaborative, in-depth diagnostic work-up is crucial for determining PFO's role in clinical conditions.
Abstract:
After extensive debate, the percutaneous closure of patent foramen ovale (PFO) has been established as a first-line treatment for the secondary prevention of PFO-related stroke in patients between 18 and 60 years old, whereas the role of PFO closure for primary prevention remains controversial. Additionally, in selected cases, PFO closure may be considered beyond these age limits and for other indications such as the treatment of systemic deoxygenation syndromes and the secondary prevention of systemic embolism or decompression sickness, when the PFO has been determined to be causative in the condition. In all cases, an in-depth diagnostic work-up, requiring collaboration among different specialists, is necessary to estimate the likelihood of PFO being related to the clinical condition. Since the first percutaneous closure of an atrial septal defect in 1976, the technique has been adapted and simplified for PFO. It is now well standardised with double-disc occluders, which are widely adopted because of their ease of use and evidence-based efficacy and safety. The procedure is generally straightforward, but some anatomical characteristics may be challenging. The choice of device and drug therapy after the procedure is currently empirical and guided by patient characteristics. Early and late complications of the procedure are infrequent but require early diagnosis. Further evidence is eagerly awaited to improve diagnosis, define other indications, make better procedural choices, and prescribe the most effective drug therapy after closure.
