Korean Circ J.  2008 Dec;38(12):631-637. 10.4070/kcj.2008.38.12.631.

Patent Foramen Ovale and Cryptogenic Stroke

• Chun KJ

• KMID: 2225695
• DOI: http://doi.org/10.4070/kcj.2008.38.12.631

Abstract

Patent foramen ovales (PFOs) are common congenital cardiac defects that have been associated with the occurrence of stroke, especially with cryptogenic stroke, or those of undefined cause, accounting for up to 40% of all ischemic strokes. A number of studies have demonstrated the association of larger PFOs with increased shunting in patients with cryptogenic strokes. Medical treatment is often considered inadequate, and percutaneous closure offers an attractive, albeit controversial, alternative in stroke patients with PFOs. Although it is plausible that percutaneous PFO closure will reduce the rate of recurrent stroke in these patients, no prospective, randomized trials examining the efficacy of closure devices in this setting have been completed. This paper reviews the known relationship between PFOs and cryptogenic strokes and discusses current therapeutic options, including percutaneous closure.

Keyword

Patent foramen ovale; Stroke; Devices

MeSH Terms

Accounting
Foramen Ovale, Patent
Humans
Stroke

Figure

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  Fig. 1 Schematic representation of the interatrial septum. After birth, there is a functional closure of the foramen ovale because left atrial (LA) pressure exceeds right atrial (RA) pressure (left). Usually, a permanent seal develops. In patients with a patent foramen ovale (PFO), the seal does not fully develop, allowing blood to flow from the RA to the LA if RA pressure rises, such as is seen with Valsalva maneuver. LV: left ventricle, RV: right ventricle.

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  Fig. 2 Amplatzer PFO occluder. PFO: patent foramen ovale.

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  Fig. 3 CardioSEAL.

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  Fig. 4 HeartStitch suturing device. A: distal end of the HeartStitch catheter. S.P: the septum primum arm, n-SP: needle of the septum primum arm, S.S: septum secundum arm, n-SS: needle of the septum secundum arm. B: handle of the HeartStitch catheter. 1: control knob for opening the septum primum arm, 2: control for firing the septum primum needle, 3: control knob for the septum secundum arm, 4: control for firing the septum secundum needle.

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  Fig. 5 PFx closure system.

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  Fig. 6 Coherex.

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