Patent foramen ovale (PFO) & stroke
Epidemiology
25% of general population
Investigation
-Only investigate if < 60y; unclear benefit > 60y, no studies
-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
>DAPT 6 mo after surgery
-Cardio interventional
>Amplatzer Talisman (Abbott)
