2006 Heart-Brain summit proceedings

Anthony J. Furlan, MD

The Department of Diagnostic Radiology
Cleveland Clinic
Cleveland, OH

furlana@ccf.org

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(Patent foramen ovale and stroke:
To close or not to close?)

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ARTICLE INTRODUCTION

Patent foramen ovale (PFO) is common, with the prevalence being approximately 20% in individuals younger than 50 years. This congenital cardiac anomaly has been found in many referral-based studies to be more common in young patients with cryptogenic stroke than in stroke of known cause. Parodoxical embolism via right-to-left shunt is the presumed mechanism of cryptogenic stroke in patients with PFO.

The diagnosis of PFO is made by either contrast transthoracic or transesophogeal echocardiography during Valsalva maneuver. Transcranial Doppler can also be used to identify paradoxical emboli in the middle cerebral artery.

PFO is considered the most common identified cause of stroke in patients younger than 50 years. However, recent data have called into question the relationship between PFO and cryptogenic ischemic stroke in the population at large, as well as the notion that paradoxical embolism through PFO is a common cause of cryptogenic ischemic stroke.

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