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Review
. 2024 May 30;14(6):706.
doi: 10.3390/life14060706.

Patent Foramen Ovale Closure in Special Clinical Situations: More Questions Than Answers?

Anastasios Apostolos  1 , Polyxeni Alexiou  1 , Amalia Papanikolaou  2 , Georgios Trantalis  1 , Maria Drakopoulou  1 , Nikolaos Ktenopoulos  1 , Ioannis Kachrimanidis  1 , Panayotis K Vlachakis  1 , Ismini Tsakiri  1 , Grigorios Chrysostomidis  3 , Konstantina Aggeli  1 , Costas Tsioufis  1 , Konstantinos Toutouzas  1
Affiliations
Review

Patent Foramen Ovale Closure in Special Clinical Situations: More Questions Than Answers?

Anastasios Apostolos et al. Life (Basel). .

Abstract

Patent foramen ovale (PFO) is a remnant of the foetal circulation resulting from incomplete occlusion of the septum primum and septum secundum. Although prevalent in about 25% of the population, it mainly remains asymptomatic. However, its clinical significance in situations such as cryptogenic stroke, migraine, and decompression illness (DCI) has been well described. Recent randomised clinical trials (RCTs) have demonstrated the efficacy of percutaneous PFO closure over pharmacological therapy alone for secondary stroke prevention in carefully selected patients. Notably, these trials have excluded older patients or those with concurrent thrombophilia. Furthermore, the role of closure in other clinical conditions associated with PFO, like decompression sickness (DCS) and migraines, remains under investigation. Our review aims to summarise the existing literature regarding epidemiology, pathophysiological mechanisms, optimal management, and closure indications for these special patient groups.

Keywords: PFO; decompression illness; migraine; older patients; patent foramen ovale; thrombophilia.

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Conflict of interest statement

The authors declare no conflicts of interest.

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