This Journal feature begins with a case vignette highlightinga common clinical problem. Evidence supporting various strategiesis then presented, followed by a review of formal guidelines,when they exist. The article ends with the authors' clinicalrecommendations.
A 38-year-old man notes abrupt loss of vision in his right visualfield while reading. He has no significant medical history andreports that he neither smokes nor uses alcohol or illicit drugs.Physical examination reveals right homonymous hemianopia butno other abnormalities. Magnetic resonance imaging reveals acuteleft occipital infarction and normal head and neck vessels.Transesophageal echocardiography shows a patent . . . [Full Text of this Article]
The Clinical Problem
Patent Foramen Ovale and the Risk of Stroke
Atrial Septal Aneurysm
Strategies and Evidence
Evaluation
Treatment
Medical Therapy
Mechanical Closure
Areas of Uncertainty
Guidelines
Conclusions and Recommendations
Source Information
From the Departments of Medicine (J.R.K., R.B.D.) and Public Health (J.R.K.), Weill Medical College of Cornell University, New York.
Address reprint requests to Dr. Kizer at Box 222, New YorkPresbyterian Hospital, 525 E. 68th St., New York, NY 10021, or at jok2007@med.cornell.edu.
Krasuski, R. A., Hart, S. A., Allen, D., Qureshi, A., Pettersson, G., Houghtaling, P. L., Batizy, L. H., Blackstone, E.
(2009). Prevalence and Repair of Intraoperatively Diagnosed Patent Foramen Ovale and Association With Perioperative Outcomes and Long-term Survival. JAMA
302: 290-297
[Abstract][Full Text]
Belton, M, Gyi, K.
(2009). Improvement in pulmonary function following closure of a patent foramen ovale in a man with cystic fibrosis. JRSM
102: 59-62
[Full Text]
Kiernan, T. J., Yan, B. P., Cubeddu, R. J., Rengifo-Moreno, P., Gupta, V., Inglessis, I., Ning, M., Demirjian, Z. N., Jaff, M. R., Buonanno, F. S., Schainfeld, R. M., Palacios, I. F.
(2009). May-Thurner Syndrome in Patients With Cryptogenic Stroke and Patent Foramen Ovale: An Important Clinical Association. Stroke
40: 1502-1504
[Abstract][Full Text]
Putaala, J., Metso, A. J., Metso, T. M., Konkola, N., Kraemer, Y., Haapaniemi, E., Kaste, M., Tatlisumak, T.
(2009). Analysis of 1008 Consecutive Patients Aged 15 to 49 With First-Ever Ischemic Stroke: The Helsinki Young Stroke Registry. Stroke
40: 1195-1203
[Abstract][Full Text]
Jones, D. A, Walker, F., Chopra, N. R, Serino, W., Huwez, F.
(2009). A woman with sudden headache followed by collapse. BMJ
338: b813-b813
[Full Text]
Windecker, S., Meier, B.
(2008). Patent Foramen Ovale and Cryptogenic Stroke: To Close or Not to Close? Closure: What Else!. Circulation
118: 1989-1997
[Full Text]
Salem, D. N., O'Gara, P. T., Madias, C., Pauker, S. G.
(2008). Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest
133: 593S-629S
[Abstract][Full Text]
Doufekias, E., Segal, A. Z., Kizer, J. R.
(2008). Cardiogenic and aortogenic brain embolism.. J Am Coll Cardiol
51: 1049-1059
[Abstract][Full Text]
Weir, N U
(2008). An update on cardioembolic stroke. Postgrad. Med. J.
84: 133-142
[Abstract][Full Text]
KAMINSKI, M. A., TAN, C. D., ASKARI, A. T.
(2008). A young man with acute weakness of his right arm. Cleveland Clinic Journal of Medicine
75: 145-152
[Full Text]
Mareedu, R. K., Shah, M. S., Mesa, J. E., McCauley, C. S.
(2007). Percutaneous Closure of Patent Foramen Ovale: A Case Series and Literature Review. Clin Med Res
5: 218-226
[Abstract][Full Text]
Gurtu, R., Grocott-Mason, R., Mason, M., Ilsley, C., Dubrey, S. W.
(2007). Paradoxical coronary emboli following a long-haul airline flight. Eur J Echocardiogr
8: 390-392
[Abstract][Full Text]
Sukernik, M. R., Bennett-Guerrero, E.
(2007). The Incidental Finding of a Patent Foramen Ovale During Cardiac Surgery: Should It Always Be Repaired? A Core Review. Anesth. Analg.
105: 602-610
[Abstract][Full Text]
Slottow, T. L. P., Steinberg, D. H., Waksman, R.
(2007). Overview of the 2007 Food and Drug Administration Circulatory System Devices Panel Meeting on Patent Foramen Ovale Closure Devices. Circulation
116: 677-682
[Abstract][Full Text]
Di Tullio, M. R., Sacco, R. L., Sciacca, R. R., Jin, Z., Homma, S.
(2007). Patent Foramen Ovale and the Risk of Ischemic Stroke in a Multiethnic Population. J Am Coll Cardiol
49: 797-802
[Abstract][Full Text]
McCabe, D J H, Rakhit, R D
(2007). Antithrombotic and interventional treatment options in cardioembolic transient ischaemic attack and ischaemic stroke. J. Neurol. Neurosurg. Psychiatry
78: 14-24
[Abstract][Full Text]
Malani, A. K., Ammar, H.
(2006). Cryptogenic stroke and patent foramen ovale.. ANN INTERN MED
145: 393-394
[Full Text]
Bonati, L. H., Kessel-Schaefer, A., Linka, A. Z., Buser, P., Wetzel, S. G., Radue, E.-W., Lyrer, P. A., Engelter, S. T.
(2006). Diffusion-Weighted Imaging in Stroke Attributable to Patent Foramen Ovale: Significance of Concomitant Atrial Septum Aneurysm. Stroke
37: 2030-2034
[Abstract][Full Text]
Adams, H. P. Jr
(2006). Cardiac Disease and Stroke: Will History Repeat Itself?. Mayo Clin Proc.
81: 597-601
[Full Text]
Albin, M. S., Wills, J., Schwend, R. M., Mazzucco, S., Anzola, G. P., Kizer, J. R., Devereux, R. B.
(2006). Patent foramen ovale and unexplained stroke.. NEJM
354: 1753-1755
[Full Text]
(2006). Perspective on PFO in Cryptogenic Stroke. JWatch Neurology
2006: 5-5
[Full Text]
Hegland, D. D., Kunz, G. A., Harrison, J. K., Wang, A.
(2005). Clinical problem-solving. A hole in the argument.. NEJM
353: 2385-2390
[Full Text]