Multidisciplinary management of patent foramen ovale (PFO) and cryptogenic stroke/TIA

Naqibullah Mirzada, Per Ladenvall, Per-Olof Hansson, Peter Eriksson, Mikael Dellborg GUCH Centre, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Dept of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy Gothenburg University, Gothenburg, Sweden Purpose: Patent foramen ovale (PFO) has been implicated as a risk factor for cryptogenic ischemic stroke (CS). However, there is still a lack of widely accepted, undisputed indications for PFO closure. The present study describes the concept of the multidisciplinary PFO conference and a decision making process for closure versus no closure that was developed into a formalized clinical algorithm, and presents the results of implementing these, in terms of number and proportion of PFO closures as well as repeat referrals. Design: Five specialists in neurology, cardiology, internal medicine, thromboembolism, and echocardiography evaluated the clinical data of 311 patients at PFO conferences during 2006 to 2009. The main criteria for closure were patients with first-ever CS with PFO and atrial septal aneurysm, or patients with recurrent CS and PFO without atrial septal aneurysm. Results: A total of 143 patients (46%) were accepted for closure and 167 patients were rejected. Patients accepted for closure were younger (mean 50 years versus 58 years) (P