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European Journal of Cardio-Thoracic Surgery, Vol 11, 824-827, Copyright © 1997 by European Association for Cardio-thoracic Surgery
P Ruchat, J Bogousslavsky, M Hurni, AP Fischer, X Jeanrenaud and LK von Segesser
OBJECTIVE: To define therapeutic strategy for management of patients with
ischemic stroke due to a high probability of paradoxical embolism through a
Patent Foramen Ovale (PFO). METHODS: Since 1988 all consecutive patients
with cerebrovascular events and PFO from the Stroke Registry of our
population-based primary-care center are prospectively studied and
followed. Since 1992, among 118 patients with cryptogenic embolic brain
infarct or transient ischemic attack (TIA) and PFO, 32 consecutive patients
younger than 60 years who presented at least two of the following criteria
were admitted for surgery: history of Valsalva strain before stroke (11);
multiple clinical events (13); multiple infarcts on brain Magnetic
Resonance Imaging (MRI) (15); atrial septal aneurysm (ASA) (16); large
right-to-left shunt (> 50 microbubbles) (12). RESULTS: Operative time
135' +/- 33'. CPB time 34' +/- 14'. Aortic crossclamping time 16' +/- 6'.
Post-operative bleeding 485 +/- 170 ml. No homologous blood transfusion
required. No neurological, cardiac or renal complications. All patients
were followed-up corresponding to a cumulative time of 601 patient-months.
This revealed no recurrent vascular events nor silent new brain lesions on
brain MRI. Systematic simultaneous contrast Trans Esophageal
Echocardiography (TEE)-Trans Cranial Doppler showed a small residual
interatrial shunt in two patients. CONCLUSION: Surgical closure of a patent
foramen ovale can be accomplished with very low morbidity and reduce
efficiently the risk of stroke recurrence. It seems to be the option of
choice in selected patients with a higher (> 1.5%/year) risk of stroke
recurrence.
ARTICLES
Systematic surgical closure of patent foramen ovale in selected patients with cerebrovascular events due to paradoxical embolism. Early results of a preliminary study
Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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  M. Argenziano PRO: The Incidental Finding of a Patent Foramen Ovale During Cardiac Surgery: Should It Always Be Repaired? Anesth. Analg., September 1, 2007; 105(3): 611 - 612. [Full Text] [PDF]
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 R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Circulation, March 14, 2006; 113(10): e409 - e449. [Abstract] [Full Text] [PDF]
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 R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, February 1, 2006; 37(2): 577 - 617. [Abstract] [Full Text] [PDF]
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 M Braun, V Gliech, A Boscheri, S Schoen, G Gahn, H Reichmann, M Haass, R Schraeder, and R.H Strasser Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism: Periprocedural safety and mid-term follow-up results of three different device occluder systems Eur. Heart J., March 1, 2004; 25(5): 424 - 430. [Abstract] [Full Text] [PDF]
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M. J Landzberg and P. Khairy Indications for the closure of patent foramen ovale Heart, February 1, 2004; 90(2): 219 - 224. [Full Text] [PDF]
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A. Khositseth, A. K. Cabalka, J. P. Sweeney, F. D. Fortuin, G. S. Reeder, H. M. Connolly, and D. J. Hagler Transcatheter Amplatzer Device Closure of Atrial Septal Defect and Patent Foramen Ovale in Patients With Presumed Paradoxical Embolism Mayo Clin. Proc., January 1, 2004; 79(1): 35 - 41. [Abstract] [PDF]
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 P. Khairy, C. P. O'Donnell, and M. J. Landzberg Transcatheter Closure versus Medical Therapy of Patent Foramen Ovale and Presumed Paradoxical Thromboemboli: A Systematic Review Ann Intern Med, November 4, 2003; 139(9): 753 - 760. [Abstract] [Full Text] [PDF]
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L. Bruch, A. Parsi, M. O. Grad, S. Rux, T. Burmeister, H. Krebs, and F. X. Kleber Transcatheter Closure of Interatrial Communications for Secondary Prevention of Paradoxical Embolism: Single-Center Experience Circulation, June 18, 2002; 105(24): 2845 - 2848. [Abstract] [Full Text] [PDF]
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 A. Wahl, B. Meier, B. Haxel, K. Nedeltchev, M. Arnold, E. Eicher, M. Sturzenegger, C. Seiler, H. P. Mattle, and S. Windecker Prognosis after percutaneous closure of patent foramen ovale for paradoxical embolism Neurology, October 9, 2001; 57(7): 1330 - 1332. [Abstract] [Full Text] [PDF]
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N. ALP, N. CLARKE, and A. P BANNING How should patients with patent foramen ovale be managed? Heart, March 1, 2001; 85(3): 242 - 244. [Full Text]
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 J. Hung, M. J. Landzberg, K. J. Jenkins, M. E. E. King, J. E. Lock, I. F. Palacios, and P. Lang Closure of patent foramen ovale for paradoxical emboli: intermediate-term risk of recurrent neurological events following transcatheter device placement J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1311 - 1316. [Abstract] [Full Text] [PDF]
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S. Windecker, A. Wahl, T. Chatterjee, A. Garachemani, F. R. Eberli, C. Seiler, and B. Meier Percutaneous Closure of Patent Foramen Ovale in Patients With Paradoxical Embolism : Long-Term Risk of Recurrent Thromboembolic Events Circulation, February 29, 2000; 101(8): 893 - 898. [Abstract] [Full Text] [PDF]
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 C. R. Thompson Echocardiography in stroke: Which probe when? Can. Med. Assoc. J., October 1, 1999; 161(8): 981 - 982. [Full Text] [PDF]
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