Abstract
A patent foramen ovale (PFO) persists in approximately 15–30% of adults, and its frequency decreases with age. In combination with predisposing morphological and hemodynamic conditions, this remnant interatrial communication promotes thromboembolic events—most notably, cerebrovascular events. Feasible treatment strategies include antithrombotic medication (antiplatelet therapy or anticoagulation), surgery, or transcatheter defect closure. Data from three large randomized controlled trials have recently provided evidence that PFO closure is associated with a lower rate of recurrent ischemic stroke than antiplatelet therapy alone in patients with a PFO and recent cryptogenic stroke. Current guidelines promote medical therapy over endovascular or surgical PFO closure as a first-line therapy in patients with cryptogenic stroke and a PFO. This chapter reviews the pathophysiology of presumed paradoxical embolism through a PFO, current guidelines, the history and current status of device technology, and critical aspects to consider when facing a residual shunt after transcatheter PFO closure.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hara H, Virmani R, Ladich E, et al. Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol. 2005;46(9):1768–76.
De Castro S, Cartoni D, Fiorelli M, et al. Morphological and functional characteristics of patent foramen ovale and their embolic implications. Stroke. 2000;31(10):2407–13.
Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55(8):1172–9.
Rigatelli G, Dell’Avvocata F, Giordan M, et al. Embolic implications of combined risk factors in patients with patent foramen ovale (the CARPE criteria): consideration for primary prevention closure? J Interv Cardiol. 2009;22(4):398–403.
Homma S, DiTullio MR, Sacco RL, Sciacca RR, Mohr JP, Investigators P. Age as a determinant of adverse events in medically treated cryptogenic stroke patients with patent foramen ovale. Stroke. 2004;35(9):2145–9.
Meissner I, Khandheria BK, Heit JA, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol. 2006;47(2):440–5.
Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A. Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med. 2007;357(22):2262–8.
Del Sette M, Angeli S, Leandri M, et al. Migraine with aura and right-to-left shunt on transcranial Doppler: a case-control study. Cerebrovasc Dis. 1998;8(6):327–30.
Cheng TO. Transcatheter closure of patent foramen ovale: a definitive treatment for platypnea–orthodeoxia. Catheter Cardiovasc Interv. 2000;51(1):120.
Germonpré P. Patent foramen ovale and diving. Cardiol Clin. 2005;23(1):97–104.
Srivastava TN, Payment MF. Images in clinical medicine. Paradoxical embolism—thrombus in transit through a patent foramen ovale. N Engl J Med. 1997;337(10):681.
Raaphorst J, Wouda EJ. Thrombus in transit through a patent foramen ovale: paradoxical embolism. J Neurol Neurosurg Psychiatry. 2005;76(9):1199.
Cohnheim J. Thrombose und Embolie. In: Vorlesungen űber Allgemeine Pathologie. Berlin: Hirschwald. p. 18771134.
Mas JL, Arquizan C, Lamy C, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med. 2001;345(24):1740–6.
Windecker S, Wahl A, Chatterjee T, et al. Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. Circulation. 2000;101(8):893–8.
Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP. Atrial anatomy in non-cardioembolic stroke patients: effect of medical therapy. J Am Coll Cardiol. 2003;42(6):1066–72.
Arauz A, Murillo L, Márquez JM, et al. Long-term risk of recurrent stroke in young cryptogenic stroke patients with and without patent foramen ovale. Int J Stroke. 2012;7(8):631–4.
Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med. 2012;366(11):991–9.
Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013;368(12):1083–91.
Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med. 2013;368(12):1092–100.
Søndergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017;377(11):1033–42.
Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377(11):1011–21.
Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017;377(11):1022–32.
Lansberg MG, O’Donnell MJ, Khatri P, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e601S–36S.
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236.
Messé SR, Gronseth G, Kent DM, et al. Practice advisory: recurrent stroke with patent foramen ovale (update of practice parameter): report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2016;87(8):815–21.
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm527096.htm (accessed January 28, 2018).
Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, Lock JE. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation. 1992;86(6):1902–8.
Mullen M. NobleStitch multi-center trial. CSI Congress 2016, Congenital, Structural & Valvular Interventions; 2016; Frankfurt.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Franke, J., Bertog, S.C., Sievert, H. (2018). Patent Foramen Ovale Closure. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_96
Download citation
DOI: https://doi.org/10.1007/978-3-319-55994-0_96
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-55993-3
Online ISBN: 978-3-319-55994-0
eBook Packages: MedicineMedicine (R0)