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Updated: Apr 15, 2026

Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Concurrent Patent Foramen Ovale and Pulmonary Arteriovenous Malformation Etiology: Complex Case of Cryptogenic Stroke
Abdullah Al Qaraghuli1, Kalyan R Chitturi2, Beni Rai Verma2
1Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
Background:
Patent foramen ovale (PFO) and pulmonary arteriovenous malformations (PAVMs) are congenital vascular abnormalities that can lead to right-to-left shunting, potentially causing paradoxical embolism.
Case Summary:
We describe a case of a 39-year-old woman who presented with syncope and left-sided facial numbness; her brain imaging confirmed a subacute lacunar infarct in the left thalamus. A transthoracic echocardiogram showed a PFO with moderate to severe right-to-left shunting. The patient underwent successful PFO closure. Postprocedurally, she developed transient hypotension. Computed tomography of the chest, abdomen, and pelvis was performed to exclude bleeding. Incidentally, a PAVM in the right middle lobe of the lung was identified, which was then successfully closed with embolization.
Discussion:
PFO is a well-established cause of paradoxical embolism, but rarer extracardiac shunts such as PAVMs can coexist and contribute to cryptogenic stroke.
Take-Home Message:
A comprehensive evaluation for multiple shunt sources is essential in younger patients with cryptogenic stroke.
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