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Patent Foramen Ovale 2023: More Lights than Shadows
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Patent Foramen Ovale 2023: More Lights than Shadows

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 25 May 2025 | Viewed by 5076

Special Issue Editors

Prof. Dr. Eustaquio Maria Onorato

E-Mail Website
Guest Editor
Cardiology Department, IRCCS University, Galeazzi Sant’Ambrogio Hospital, Via Cristina Belgioioso, 173, 20157 Milan, Italy
Interests: interventional cardiology; congenital and structural heart diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Christian Pristipino

E-Mail Website
Guest Editor
San Filippo Neri, ASL Roma 1 Hospital, Viale Vaticano 68A, 00165 Roma, Italy
Interests: patent foramen ovale; interventional cardiology; ischemic heart disease; systems medicine

Special Issue Information

Dear Colleagues,

Patent foramen ovale (PFO) represents a benign common abnormality affecting up to 30% of the general population. Nevertheless, in some cases, the PFO can open widely, leading to the paradoxical shunting of blood or thrombotic material from the venous to arterial circulation, which is associated with stroke and systemic embolization. In fact, one-third of ischemic strokes are considered to be PFO-related, and the majority of them are thought to be caused by a paradoxical embolism via the PFO. Four recent randomized control trials have provided strong and objective evidence that percutaneous PFO closure with long-term antiplatelet therapy over antithrombotic therapy alone is associated with reduced rates of recurrent stroke. Remarkably, PFO can be associated with other pathologic conditions such as decompression illness, platypnea–orthodeoxia, migraine with aura, paradoxical coronary embolism, major orthopaedic surgery, posterior fossa neurosurgery, obstructive sleep apnea, and arterial deoxygenation, which have been defined as PFO-associated syndromes. Those patients need to be approached within a multidisciplinary framework, wherein shared decision making becomes essential.

Areas for future study include the role of new PFO closure devices, platelet hyperactivity in migraine aura patients with PFO, new markers to aid in the determination of the role of PFO closure in individual patients, the role of oral anticoagulants, particularly direct oral anticoagulants, the role of PFO in stroke occurring in patients older than 60 years old, the possible efficacy of primary prevention in selected populations, and very long-term outcomes after device closure. In addition, how close are we to PFO closure be a standard indication for selected aura migraine patients.

Prof. Dr. Eustaquio Maria Onorato
Dr. Christian Pristipino
Guest Editors

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Keywords

  • patent foramen ovale
  • patent foramen ovale closure
  • paradoxical embolism
  • right-to-left shunt
  • stroke
  • cryptogenic stroke
  • decompression illness
  • migraine aura
  • platypnea–orthodeoxia syndrome
  • posterior fossa neurosurgery
  • major orthopaedic surgery and paradoxical fat embolism

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Published Papers (2 papers)

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9 pages, 476 KiB  
Article
Comparative Effectiveness of Devices for Interventional Patent Foramen Ovale Closure: Insights from a 23-Year Monocentric Analysis
by Elham Kayvanpour, Elena Matzeit, Ziya Kaya, Sven Pleger, Anke Bahrmann, Christine Reichardt, Peter Arthur Ringleb, Norbert Frey, Benjamin Meder and Farbod Sedaghat-Hamedani
J. Clin. Med. 2024, 13(21), 6354; https://doi.org/10.3390/jcm13216354 - 23 Oct 2024
Cited by 1 | Viewed by 1466
Abstract
Background/Objectives: Patent foramen ovale (PFO) is a congenital heart defect affecting up to 25% of the population, associated with an increased risk of cryptogenic stroke. Percutaneous PFO closure is a minimally invasive procedure aimed at reducing stroke risk by eliminating the right-to-left shunt. [...] Read more.
Background/Objectives: Patent foramen ovale (PFO) is a congenital heart defect affecting up to 25% of the population, associated with an increased risk of cryptogenic stroke. Percutaneous PFO closure is a minimally invasive procedure aimed at reducing stroke risk by eliminating the right-to-left shunt. Methods: This monocentric, retrospective study analyzed 716 patients who underwent PFO closure between January 2000 and February 2023. Data collected included demographics, indications for closure, procedural details, and outcomes. Key endpoints were complications at the puncture site, pericardial effusion, recurrent stroke or transient ischemic attack (TIA), thrombi on the device, new-onset atrial fibrillation, and death. Results: The cohort had a mean age of 50.6 ± 12.6 years, with 60.8% female. Four devices were used: Occlutech PFO occluder (n = 106), Amplatzer PFO occluder (n = 227), Gore septal occluder (n = 296), and Cardia PFO-Star (n = 87). The initial procedural success rate was 98.9%, with no significant differences between devices. Complication rates were low across all devices. Residual shunt incidence decreased from 17.9% in 1 month to 3.4% in 12 months. Device-specific complications included late-onset pericardial effusion (p = 0.01), erosions (Cardia PFO-Star), and device thrombus formation (Gore septal occluder). Conclusions: PFO closure is a safe and effective method for preventing recurrent strokes, with high success rates and varying specific complication profiles, depending on the device. Further long-term studies are needed to evaluate newer devices and optimize patient outcomes. Full article
(This article belongs to the Special Issue Patent Foramen Ovale 2023: More Lights than Shadows)
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Review

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18 pages, 1818 KiB  
Review
Every Patent Foramen Ovale Should Be Closed
by Bernhard Meier
J. Clin. Med. 2024, 13(11), 3355; https://doi.org/10.3390/jcm13113355 - 6 Jun 2024
Cited by 1 | Viewed by 2934
Abstract
At present, the patent foramen ovale (PFO) does not receive the deserved medical attention. The PFO poses a serious threat to health and even the life of mankind. The first respective case report in the medical literature dates back to the 19th century. [...] Read more.
At present, the patent foramen ovale (PFO) does not receive the deserved medical attention. The PFO poses a serious threat to health and even the life of mankind. The first respective case report in the medical literature dates back to the 19th century. It led to death. The fact that a PFO is present in roughly 25% of people underscores its overall potential to cause harm. Yet at the same time, the sheer number discourages the medical community from screening for it and from treating it. About 5% of the population have particularly dangerous forms of PFOs. Such PFOs portray a high enough risk for clinical events, the likes of death, stroke, myocardial infarction, or ocular, visceral, and peripheral embolism, to justify screening for them. Highly significant health incidents being at stake, it appears obvious that PFO closure should be used for primary prevention. This is supported by the fact that closing a PFO is the simplest intervention in cardiology, with presumably the highest clinical yield. Being mainly a preventive measure, PFO closure represents a mechanical vaccination. When closing PFOs for one of the rarer therapeutic indications (migraine, platypnea orthodeoxia, etc.), patients automatically profit from the collateral benefit of getting, at the same time, mechanically vaccinated for life against paradoxical embolism. Vice versa, closing a PFO for the prevention of paradoxical embolism betters or cures migraine or exercise dyspnea not infrequently, thereby improving quality of life as a collateral benefit. Full article
(This article belongs to the Special Issue Patent Foramen Ovale 2023: More Lights than Shadows)
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