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  • Review Article
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Patent foramen ovale and cerebrovascular diseases

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 446–455 (2006)Cite this article

Abstract

Patent foramen ovale (PFO) has been linked to ischemic strokes of undetermined cause (cryptogenic strokes). PFO—a remnant of fetal circulation when the foramen ovale does not seal after birth—can permit microemboli to escape the pulmonary filter into the intracranial circulation, causing stroke. Coexistent atrial septal aneurysm, pelvic deep vein thrombosis and inherited clotting factor deficiencies could potentiate stroke risk in patients with PFO. Transcatheter PFO closure, a minimally invasive procedure, is one technique used to prevent recurrent cerebrovascular events. A connection between PFO and migraine headache has been conceptualized from retrospective evidence of reduced migraine frequency and severity after PFO closure; however, prospective randomized trials are needed to verify the efficacy of PFO closure on migraine prevention. In this review we discuss embryologic origins, diagnostic techniques and treatment options for prevention of paradoxical embolism thought to be related to PFO, and the relation of PFO to cryptogenic stroke and migraine.

Key Points

  • More than 40% of all ischemic strokes have no identifiable cause and are classified as cryptogenic

  • Paradoxical emboli, through a right-to-left shunt, have been implicated as a cause of cryptogenic stroke

  • Patent foramen ovale, the most common cause of a right-to-left shunt, can be detected noninvasively by agitated saline bubble study during echocardiography or transcranial Doppler imaging

  • Transcatheter closure of patent foramen ovale has been developed as a minimally invasive alternative for prevention of stroke caused by paradoxical emboli

  • Transcatheter patent foramen ovale closure has been associated with a reduction or cessation of complex migraine headaches with aura in nonrandomized studies

  • Randomized trials are underway to evaluate the efficacy of transcatheter patent foramen ovale closure on prevention of recurrent ischemic stroke and complex migraine

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Figure 1: Autopsy specimen illustrating patent foramen ovale, as viewed from the left atrium
Figure 2: Power motion-mode transcranial Doppler imaging in a patient with a 12 mm diameter patent foramen ovale

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Author information

Authors and Affiliations

  1. Interventional Cardiologist and Clinical Research and Education Project Director,

    Amish J Desai, Cindy J Fuller, Jill T Jesurum & Mark Reisman

  2. Research Associate,

    Amish J Desai, Cindy J Fuller, Jill T Jesurum & Mark Reisman

  3. Clinical Research Scientist,

    Amish J Desai, Cindy J Fuller, Jill T Jesurum & Mark Reisman

  4. Director of Cardiac Catheterization and Research at the Departments of Cardiovascular Research and Scientific Development, Swedish Medical Center, Seattle, WA, USA

    Amish J Desai, Cindy J Fuller, Jill T Jesurum & Mark Reisman

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  1. Amish J Desai
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Correspondence to Amish J Desai.

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Desai, A., Fuller, C., Jesurum, J. et al. Patent foramen ovale and cerebrovascular diseases. Nat Rev Cardiol 3, 446–455 (2006). https://doi.org/10.1038/ncpcardio0597

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