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Anatomical features of percutaneously closed patent foramen ovale in patients with cryptogenic stroke

Maikel H M Immens1, Lars S Witte2, Abdelhak El Bouziani2

  • 1Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|September 15, 2025
PubMed
Abstract

Insights

Patent foramen ovale (PFO) closure is common for cryptogenic stroke, but 20% of patients lacked typical risk factors. Individual assessment by a Heart-Stroke Team is crucial for PFO-related stroke management.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Diagnostics

Background:

  • Patent foramen ovale (PFO) is a common condition, found in ~25% of the general population.
  • PFO is increasingly recognized as a cause of cryptogenic stroke, particularly in younger individuals.
  • Identifying PFO as the cause of stroke is crucial for appropriate patient management.

Purpose of the Study:

  • To examine the anatomical characteristics of PFOs in patients who underwent percutaneous PFO closure for cryptogenic stroke.
  • To assess the prevalence of risk-enhancing PFO features in patients undergoing closure.
  • To evaluate the role of interdisciplinary Heart-Stroke Teams (HST) in patient selection.

Main Methods:

  • Retrospective data collection of patients undergoing PFO closure between 2016 and 2022.
  • Transesophageal echocardiography was used to measure PFO anatomical characteristics.
  • Analysis performed by two experienced cardiologists.

Main Results:

  • 223 patients underwent PFO closure, with a mean age of 42.8 years.
  • Over 80% of patients exhibited at least one risk-enhancing PFO feature (moderate-to-severe shunt and/or atrial septal aneurysm >10 mm).
  • Despite HST assessment, 20% of closed PFOs lacked these specific risk-enhancing features.

Conclusions:

  • Individualized assessment by a Heart-Stroke Team is vital for managing young stroke patients with PFO.
  • A significant proportion of patients undergoing PFO closure may not present with all typical risk-enhancing features.
  • Further research is needed to elucidate stroke mechanisms in PFO patients without clear risk factors.
Keywords:
Anatomical featuresPatent Foramen OvalePercutaneous closureStroke

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