Patent foramen ovale closure

A patent foramen ovale (PFO) is quite common and persists in approximately 20–30% of adults. In combination with predisposing morphologic and hemodynamic conditions, this remnant interatrial communication promotes thromboembolic events, most notably cerebrovascular events. Feasible treatment strategies include antithrombotic medication (antiplatelet therapy or anticoagulation), surgery, or transcatheter defect closure. Though to date no randomized trials exist showing that medical therapy versus placebo in any patient population with cryptogenic stroke is truly effective in preventing recurrent events, current guidelines promote medical therapy over endovascular or surgical PFO closure as a first-line therapy in patients with cryptogenic stroke and a PFO. This chapter reviews the pathophysiology of presumed paradoxical embolism through a PFO, current guidelines, the history and current status of device technology, and critical aspects to consider when facing a residual shunt after transcatheter PFO closure.