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(Circulation. 2005;112:1063-1072.)
© 2005 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Patent Foramen Ovale and Stroke

Shunichi Homma, MD; Ralph L. Sacco, MD

From the Division of Cardiology (S.H.) and Neurological Institute (R.L.S.), Columbia University, New York, NY.

Correspondence to Shunichi Homma, MD, Division of Cardiology, Columbia University, College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032. E-mail sh23@columbia.edu

Key Words: anticoagulants • aspirin • embolism • heart septal defects, atrial • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
This review summarizes the current state of knowledge about the relationship of patent foramen ovale (PFO) with ischemic stroke. Initial sections discuss the studies that identified this association. Subsequent sections discuss the detection techniques for PFO and other variables that may cause a PFO to be a conduit of paradoxical embolization. Finally, a section is devoted to summarizing the studies that assessed the strategies for preventing recurrent ischemic events in patients with PFO.

	Cryptogenic Stroke and PFO

 
In 40% of patients with acute ischemic stroke, the cause remains undefined.¹ PFO is a hemodynamically insignificant interatrial communication present in >25% of the adult population. During fetal life, because the lungs do not receive blood flow, blood returning to the right atrium is shunted through a PFO to the left atrium. Postnatally, PFO closes spontaneously in 75% of the population. However, in a portion of adults, by maintaining a direct communication between the right- and left-sided circulation, PFO can serve as a conduit for paradoxical embolization.

In 1877, Cohnheim² described the association of PFO with stroke in a young woman with cerebral arterial embolism. However, it has been difficult to diagnose PFO in vivo until the development of echocardiography and its ability to image the interatrial shunting with an injection of saline contrast. With the use of contrast echocardiography, a strong association of cryptogenic stroke with PFO has become evident in patients <55 years of age (Table 1).^3–8

View this table: [in this window] [in a new window]   TABLE 1. Relationship of Cryptogenic Stroke With PFO in Younger and Older Patients

Because stroke occurs . . . [Full Text of this Article]

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