Abstract
For more than two decades, the role of patent foramen ovale (PFO) as a source for
cardioembolic ischemic stroke or transient ischemic attack (TIA) and its therapy are
discussed controversially. Since the introduction of interventional transcatheter
closure devices the number of such interventions is increasing. This article summarizes
current research regarding the association of PFO and cerebrovascular ischemic events,
presents current knowledge regarding medical and interventional treatment options
and gives recommendations for treatment decision making in individual patients.
Literatur
- 1
Hagen P T, Scholz D G, Edwards W D.
Incidence and size of patent foramen ovale during the first 10 decades of life: an
autopsy study of 965 normal hearts.
Mayo Clin Proc.
1984;
59
17-20
- 2
Meissner I, Khandheria B K, Heit J A et al.
Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based
study.
J Am Coll Cardiol.
2006;
47
440-445
- 3
Schneider B, Zienkiewicz T, Jansen V et al.
Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation
with autopsy findings.
Am J Cardiol.
1996;
77
1202-1209
- 4
Hansen A, Kuecherer H.
Caught in the act: entrapped embolus through a patent foramen ovale.
Eur J Echocardiogr.
2008;
9
692-693
- 5
Thanigaraj S, Zajarias A, Valika A et al.
Caught in the act: serial, real time images of a thrombus traversing from the right
to left atrium across a patent foramen ovale.
Eur J Echocardiogr.
2006;
7
179-181
- 6
Berthet K, Lavergne T, Cohen A et al.
Significant association of atrial vulnerability with atrial septal abnormalities in
young patients with ischemic stroke of unknown cause.
Stroke.
2000;
31
398-403
- 7
Overell J R, Bone I, Lees K R.
Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies.
Neurology.
2000;
55
1172-1179
- 8
Force M, Massabuau P, Larrue V.
Prevalence of atrial septal abnormalities in older patients with cryptogenic ischemic
stroke or transient ischemic attack.
Clin Neurol Neurosurg.
2008;
110
779-783
- 9
Handke M, Harloff A, Olschewski M et al.
Patent foramen ovale and cryptogenic stroke in older patients.
N Engl J Med.
2007;
357
2262-2268
- 10
Mattle H P, Meier B, Nedeltchev K.
Prevention of stroke in patients with patent foramen ovale.
Int J Stroke.
2010;
5
92-102
- 11
Di Tullio M R, Sacco R L, Sciacca R R et al.
Patent foramen ovale and the risk of ischemic stroke in a multiethnic population.
J Am Coll Cardiol.
2007;
49
797-802
- 12
Carpenter D A, Ford A L, Lee J M.
Patent foramen ovale and stroke: Should PFOs be closed in otherwise cryptogenic stroke?.
Curr Atheroscler Rep.
2010;
12
251-258
- 13
Cramer S C, Rordorf G, Maki J H et al.
Increased pelvic vein thrombi in cryptogenic stroke: results of the Paradoxical Emboli
from Large Veins in Ischemic Stroke (PELVIS) study.
Stroke.
2004;
35
46-50
- 14
Bogousslavsky J, Garazi S, Jeanrenaud X et al.
Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne
Stroke with Paradoxal Embolism Study Group.
Neurology.
1996;
46
1301-1305
- 15
Lethen H, Flachskampf F A, Schneider R et al.
Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic
stroke or transient ischemic attack.
Am J Cardiol.
1997;
80
1066-1069
- 16
Mas J L, Arquizan C, Lamy C et al.
Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal
aneurysm, or both.
N Engl J Med.
2001;
345
1740-1746
- 17
Homma S, Sacco R L, Di Tullio M R et al.
Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen
ovale in Cryptogenic Stroke Study.
Circulation.
2002;
105
2625-2631
- 18
Serena J, Marti-Fabregas J, Santamarina E et al.
Recurrent stroke and massive right-to-left shunt: results from the prospective Spanish
multicenter (CODICIA) study.
Stroke.
2008;
39
3131-3136
- 19
Messe S R, Silverman I E, Kizer J R et al.
Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm:
report of the Quality Standards Subcommittee of the American Academy of Neurology.
Neurology.
2004;
62
1042-1050
- 20
Almekhlafi M A, Wilton S B, Rabi D M et al.
Recurrent cerebral ischemia in medically treated patent foramen ovale: a meta-analysis.
Neurology.
2009;
73
89-97
- 21
Nedeltchev K, Arnold M, Wahl A et al.
Outcome of patients with cryptogenic stroke and patent foramen ovale.
J Neurol Neurosurg Psychiatry.
2002;
72
347-350
- 22 Deutsche Gesellschaft für Neurologie .Primär- und Sekundärprävention der zerebralen
Ischämie. Gemeinsame Leitlinie der DGN und der Deutschen Schlaganfallgesellschaft
(DSG) 2008. http://www.dsg-info.de/images/stories/DSG/PDF/Leitlinien/ll08kap_024.pdf ; Stand: 4.10.2010
- 23
King T D, Thompson S L, Steiner C et al.
Secundum atrial septal defect. Nonoperative closure during cardiac catheterization.
JAMA.
1976;
235
2506-2509
- 24
Bridges N D, Hellenbrand W, Latson L et al.
Transcatheter closure of patent foramen ovale after presumed paradoxical embolism.
Circulation.
1992;
86
1902-1908
- 25
Taaffe M, Fischer E, Baranowski A et al.
Comparison of three patent foramen ovale closure devices in a randomized trial (Amplatzer
versus CardioSEAL-STARflex versus Helex occluder).
Am J Cardiol.
2008;
101
1353-1358
- 26
Martin F, Sanchez P L, Doherty E et al.
Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical
embolism.
Circulation.
2002;
106
1121-1126
- 27
Wahl A, Meier B.
Patent foramen ovale and ventricular septal defect closure.
Heart.
2009;
95
70-82
- 28
Krumsdorf U, Ostermayer S, Billinger K et al.
Incidence and clinical course of thrombus formation on atrial septal defect and patient
foramen ovale closure devices in 1,000 consecutive patients.
J Am Coll Cardiol.
2004;
43
302-309
- 29
Kiblawi F M, Sommer R J, Levchuck S G.
Transcatheter closure of patent foramen ovale in older adults.
Catheter Cardiovasc Interv.
2006;
68
136-142; discussion 143 – 144
- 30
Alaeddini J, Feghali G, Jenkins S et al.
Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen
ovale.
J Invasive Cardiol.
2006;
18
365-368
- 31
Dowson A, Mullen M J, Peatfield R et al.
Migraine Intervention With STARFlex Technology (MIST) trial: a prospective, multicenter,
double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen
ovale closure with STARFlex septal repair implant to resolve refractory migraine headache.
Circulation.
2008;
117
1397-1404
- 32
Braun M, Gliech V, Boscheri A et al.
Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism.
Periprocedural safety and mid-term follow-up results of three different device occluder
systems.
Eur Heart J.
2004;
25
424-430
- 33
Windecker S, Wahl A, Nedeltchev K et al.
Comparison of medical treatment with percutaneous closure of patent foramen ovale
in patients with cryptogenic stroke.
J Am Coll Cardiol.
2004;
44
750-758
- 34
Schuchlenz H W, Weihs W, Berghold A et al.
Secondary prevention after cryptogenic cerebrovascular events in patients with patent
foramen ovale.
Int J Cardiol.
2005;
101
77-82
- 35 http://www.theheart.org/article/1088789.do Stand: 4. 10. 2010
Lars-Peder Pallesen
Dresdner Universitäts Schlaganfall Centrum, Klinik für Neurologie
Universitätsklinik Dresden
Fetscherstraße 74
01307 Dresden
Email: Lars-Peder.Pallesen@uniklinikum-dresden.de