Patent Foramen Ovale Closure
Authors: William G. Kussmaul
Journal: Annals of Internal Medicine (2018)

Editorials6 March 2018Patent Foramen Ovale ClosureWilliam G. Kussmaul III, MDWilliam G. Kussmaul III, MDMedia, Pennsylvania (W.G.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Mechanical closure of a patent foramen ovale (PFO) without surgery has been possible since 1992 (1). Highly prevalent (2) but usually clinically silent, a PFO can permit right-to-left shunting of deoxygenated blood and, even worse, allow venous system thromboemboli to cross the atrial septum into the systemic circulation. A substantial proportion of apparently “cryptogenic” strokes may result from such an event (3).Should a PFO be closed if it seems to have caused a stroke? Reasonable as this approach sounds, there are (as always) risks, costs, and benefits to balance. The closure procedure is invasive, expensive, and not without risk. ...References1. Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, Lock JE. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation. 1992;86:1902-8. [PMID: 1451261] CrossrefMedlineGoogle Scholar2. Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984;59:17-20. [PMID: 6694427] CrossrefMedlineGoogle Scholar3. Lechat P, Mas JL, Lascault G, Loron P, Theard M, Klimczac M, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318:1148-52. [PMID: 3362165] CrossrefMedlineGoogle Scholar4. Messé SR, Gronseth G, Kent DM, Kizer JR, Homma S, Rosterman L, et al. 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Søndergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, et al; Gore REDUCE Clinical Study Investigators. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017;377:1033-1042. [PMID: 28902580] doi:10.1056/NEJMoa1707404 CrossrefMedlineGoogle Scholar7. Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, et al; CLOSE Investigators. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377:1011-1021. [PMID: 28902593] doi:10.1056/NEJMoa1705915 CrossrefMedlineGoogle Scholar8. Shah R, Nayyar M, Jovin IS, Rashid A, Bondy BR, Fan THM, et al. Device closure versus medical therapy alone for patent foramen ovale in patients with cryptogenic stroke. A systematic review and meta-analysis. Ann Intern Med. 2018;168:335-42. doi:10.7326/M17-2679 LinkGoogle Scholar9. De Rosa S, Sievert H, Sabatino J, Polimeni A, Sorrentino S, Indolfi C. Percutaneous closure versus medical treatment in stroke patients with patent foramen ovale. A systematic review and meta-analysis. Ann Intern Med. 2018;168:343-50. doi:10.7326/M17-3033 LinkGoogle Scholar10. Merkler AE, Gialdini G, Yaghi S, Okin PM, Iadecola C, Navi BB, et al. Safety outcomes after percutaneous transcatheter closure of patent foramen ovale. Stroke. 2017;48:3073-3077. [PMID: 28939677] doi:10.1161/STROKEAHA.117.018501 CrossrefMedlineGoogle Scholar11. Jalal Z, Hascoet S, Baruteau AE, Iriart X, Kreitmann B, Boudjemline Y, et al. Long-term Complications After Transcatheter Atrial Septal Defect Closure: A Review of the Medical Literature. Can J Cardiol. 2016;32:1315. [PMID: 27179546] doi:10.1016/j.cjca.2016.02.068 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Media, Pennsylvania (W.G.K.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0024.Corresponding Author: William G. Kussmaul III, MD, 5 Arrowhead Trail, Media, PA 19063; e-mail, w.[email protected]net.This article was published at Annals.org on 9 January 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPercutaneous Closure Versus Medical Treatment in Stroke Patients With Patent Foramen Ovale Salvatore De Rosa , Horst Sievert , Jolanda Sabatino , Alberto Polimeni , Sabato Sorrentino , and Ciro Indolfi Device Closure Versus Medical Therapy Alone for Patent Foramen Ovale in Patients With Cryptogenic Stroke Rahman Shah , Mannu Nayyar , Ion S. Jovin , Abdul Rashid , Beatrix R. Bondy , Tai-Hwang M. Fan , Michael P. Flaherty , and Sunil V. Rao Metrics 6 March 2018Volume 168, Issue 5Page: 367-368KeywordsAtrial septal defectBloodCardiac surgeryConflicts of interestDeep vein thrombosisDisclosureMedical risk factorsRandomized trialsStrokeSurgery ePublished: 9 January 2018 Issue Published: 6 March 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...