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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Stroke Prevention in Pregnancy and Postpartum in Patients With Patent Foramen Ovale
Grace B Russo1, Stephanie E Purisch2, Malamo E Countouris3
1Department of Neurology, Division of Stroke, New York University Grossman School of Medicine, New York, New York, USA.
Abstract:
Pregnancy and patent foramen ovale (PFO) are both stroke risk factors in young people. There are currently no guidelines for mitigating PFO-related stroke risk during pregnancy. We summarize the pathophysiology of PFO-related stroke and offer our approaches to primary and secondary stroke prevention for pregnant patients with PFO. We present 5 clinical scenarios: incidentally identified PFO in a pregnant patient without a stroke history; considerations for PFO screening and primary stroke prevention in select patients at unusually high risk of stroke in pregnancy; planning for pregnancy after a PFO-related stroke; PFO-related stroke occurring in pregnancy; and pregnancy planning for a patient with PFO identified after a transient neurological episode of unclear cause. Through these scenarios, we highlight the unique treatment considerations and challenges of primary and secondary PFO-related stroke prevention during this high-risk period. Collaboration between neurology, cardiology, and maternal-fetal medicine is integral for the successful management of these patients.
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