Current indications for percutaneous closure of patent foramen ovale.

Patent foramen ovale (PFO) occurs when the septum primum and secundum fail to fuse after birth. A quarter of adults have this defect, which is usually an incidental finding with no clinical repercussions. However, the presence of PFO has been associated with a range of clinical conditions such as cryptogenic stroke, migraine, platypnea-orthodeoxia syndrome, and decompression illness. Cryptogenic stroke accounts for up to 40% of all ischemic strokes. There has been heated debate about the role of percutaneous closure of PFO in patients with cryptogenic stroke. Recently, 3 randomized studies have been published (CLOSURE, RESPECT, and PC-trial). None of these demonstrated that percutaneous closure was associated with a decreased incidence of stroke compared to medical treatment with antiplatelet agents or anticoagulants. Nevertheless, some subanalyses and metaanalyses of these studies have shown that percutaneous closure of PFO could be beneficial for certain patient groups.