Patent foramen ovale (PFO) & stroke
Epidemiology
25% of general population
Investigation
- only investigate if < 60y
- TTE/TCD should be followed by TEE
- Duplex US of all limbs
- embolic appearance stroke
Spencer Scale (bubble study)
1-5 bubbles: minimal
6-20 bubbles: moderate
> 20 bubbles: severe
Clinical clues
- co-occurrence of pulmonary emboli
- venous source embolism
Likelihood of stroke
- Calculate ROPE (Risk of Paradoxical Embolism) score
> compare the data with PASCAL (PFO-Associated Stroke Causal Likelihood)
Dangerous PFO types
- large PFO
- association with atrial septal aneurysm
- long Eustechian valve
- long PFO tunnel
- basal right to left shunt
Risk recurrence
- 0-14%
- higher w/ atrial septal aneurysm
Management
- AC
- if AC not possible:
> venous embolism - IVC filter
> if no venous embolism - antiplatelet monotherapy
- surgery
> no statistical benefit
> complications: shunts and arrhythmias