Textbook of Catheter-Based Cardiovascular Interventions pp 1689-1696 | Cite as
Patent Foramen Ovale Closure
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.
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