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Patent foramen ovale closure review: decades of research and the evolution of the evidence

Abstract:
Abstract Background A quarter of the population suffers from patent foramen ovale, a form of interatrial shunt. It has been linked to cryptogenic strokes and is a common cause of paradoxical embolism. Main text The benefit of closing the patent foramen ovale in cryptogenic stroke patients aged 18-60 years to prevent recurrent strokes, particularly in those with large shunts or associated atrial septal aneurysms, was recently demonstrated. It is a relatively safe procedure that necessitates post-operative anticoagulation, but it has been linked to new-onset atrial fibrillation of uncertain significance. The effectiveness of patent foramen closure depends on patient selection, and prediction scores such as the Risk of Paradoxical Embolism (RoPE) score should be used. Newer closure devices, such as bioabsorbable devices like the Biostar system and ‘device-less’ devices like the Noble Stitch, are becoming more common due to their lower operative risks. The use of such devices in future trials, as well as careful case selection, could improve the acceptability of patent foramen ovale closure in the general population, removing the need for perioperative anticoagulation. Conclusion Individuals aged 18-60 years with cryptogenic stroke who have adverse patent foramen ovale morphology on imaging should be offered patent foramen ovale closure, preferably using the newer closure devices. More studies are needed to determine the significance of periprocedural atrial fibrillation after device closure.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1186/s43162-021-00059-8

Authors

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Institution:
University of Oxford
Division:
MSD
Department:
Nuffield Department of Population Health
Role:
Author
ORCID:
0000-0001-8802-8590


Publisher:
SpringerOpen
Journal:
The Egyptian Journal of Internal Medicine More from this journal
Volume:
33
Issue:
1
Pages:
26
Article number:
26
Publication date:
2021-08-09
DOI:
EISSN:
2090-9098
ISSN:
1110-7782


Language:
English
Keywords:
Pubs id:
1532745
Local pid:
pubs:1532745
Source identifiers:
W3189126009
Deposit date:
2026-05-17
ARK identifier:
This ORA record was generated from metadata provided by an external service. It has not been edited by the ORA Team.

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