Patent Foramen Ovale: A Villain in Pulmonary Embolism?
Authors: Michael Rahbek Schmidt, Lars Søndergaard
Journal: Annals of Internal Medicine (2019)

Editorials4 June 2019Patent Foramen Ovale: A Villain in Pulmonary Embolism?Michael Rahbek Schmidt, MD, PhD and Lars Søndergaard, MD, MScMichael Rahbek Schmidt, MD, PhDRigshospitalet, Copenhagen, Denmark (M.R.S., L.S.) and Lars Søndergaard, MD, MScRigshospitalet, Copenhagen, Denmark (M.R.S., L.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1089 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The importance and causal relevance of patent foramen ovale (PFO) in cryptogenic stroke has been debated for more than 3 decades. Although the anatomical and physiologic foundation for paradoxical embolisms through the PFO was eagerly adopted as a likely explanation in patients with an unexplained ischemic stroke, the reported PFO prevalence of 15% to 30% in the background population indicates that the condition carries a relatively low risk for complications.Indeed, the presence of PFO per se does not increase risk for ischemic stroke in a general population (1), but it increases risk for recurrent stroke in patients who already ...References1. Di Tullio MR, Sacco RL, Sciacca RR, Jin Z, Homma S. Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. J Am Coll Cardiol. 2007;49:797-802. [PMID: 17306710] CrossrefMedlineGoogle Scholar2. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, et al; RESPECT Investigators. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017;377:1022-32. [PMID: 28902590] doi:10.1056/NEJMoa1610057 CrossrefMedlineGoogle Scholar3. 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;377:1033-42. [PMID: 28902580] doi:10.1056/NEJMoa1707404 CrossrefMedlineGoogle Scholar4. 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;377:1011-21. [PMID: 28902593] doi:10.1056/NEJMoa1705915 CrossrefMedlineGoogle Scholar5. Doyen D, Castellani M, Moceri P, Chiche O, Lazdunski R, Bertora D, et al. Patent foramen ovale and stroke in intermediate-risk pulmonary embolism. Chest. 2014;146:967-73. [PMID: 24874409] doi:10.1378/chest.14-0100 CrossrefMedlineGoogle Scholar6. Goliszek S, Wisniewska M, Kurnicka K, Lichodziejewska B, Ciurzynski M, Kostrubiec M, et al. Patent foramen ovale increases the risk of acute ischemic stroke in patients with acute pulmonary embolism leading to right ventricular dysfunction. Thromb Res. 2014;134:1052-6. [PMID: 25282541] doi:10.1016/j.thromres.2014.09.013 CrossrefMedlineGoogle Scholar7. Clergeau MR, Hamon M, Morello R, Saloux E, Viader F, Hamon M. Silent cerebral infarcts in patients with pulmonary embolism and a patent foramen ovale: a prospective diffusion-weighted MRI study. Stroke. 2009;40:3758-62. [PMID: 19797184] doi:10.1161/STROKEAHA.109.559898 CrossrefMedlineGoogle Scholar8. Vindiš D, Hutyra M, Šanák D, Král M, Cecháková E, Littnerová S, et al. Patent foramen ovale and the risk of cerebral infarcts in acute pulmonary embolism—a prospective observational study. J Stroke Cerebrovasc Dis. 2018;27:357-64. [PMID: 29031497] doi:10.1016/j.jstrokecerebrovasdis.2017.09.004 CrossrefMedlineGoogle Scholar9. Le Moigne E, Timsit S, Ben Salem D, Didier R, Jobic Y, Paleiron N, et al. Patent foramen ovale and ischemic stroke in patients with pulmonary embolism. A prospective cohort study. Ann Intern Med. 2019;170:756-63. doi:10.7326/M18-3485 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Rigshospitalet, Copenhagen, Denmark (M.R.S., L.S.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1089.Corresponding Author: Lars Søndergaard, MD, MSc, Kardiologisk Klinik B 2011, Blegdamsvej 9, 2100 København, Denmark; e-mail, lars.soendergaard.[email protected]dk.Current Author Addresses: Drs. Schmidt and Søndergaard: Kardiologisk Klinik B 2011, Blegdamsvej 9, 2100 København, Denmark.This article was published at Annals.org on 7 May 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPatent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism Emmanuelle Le Moigne , Serge Timsit , Douraied Ben Salem , Romain Didier , Yannick Jobic , Nicolas Paleiron , Raphael Le Mao , Thierry Joseph , Clément Hoffmann , Angelina Dion , Jean Rousset , Grégoire Le Gal , Karine Lacut , Christophe Leroyer , Dominique Mottier , and Francis Couturaud Metrics Cited byStep-by-Step Device Closure of Persistent Foramen Ovale (PFO)Neurologic complications of venous thromboembolismThe Full Spectrum of PFO 4 June 2019Volume 170, Issue 11Page: 805-806KeywordsClinical trialsEchocardiographyIschemic strokeMagnetic resonance imagingMedical risk factorsPatient advocacyPatientsPulmonary embolismRisk managementStroke ePublished: 7 May 2019 Issue Published: 4 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...