Materiały źródłowe

• #1 Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7198765/

  Patent foramen ovale (PFO) prevalence was 24.2% (1,872/7,747) in autopsy studies, 23.7% (325/1,369) in TEE, 31.3% (111/355) in TCD, and 14.7% (186/1,267) in TTE studies. […] All diagnostic modalities included PFO prevalence was higher in CE compared with healthy/control population [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 2.53.8] and compared with non-CE (OR = 2.3, 95% CI = 2.02.6). […] Given the limitations of autopsy and TEE studies, there is good reason not to take a fixed 25% PFO prevalence for granted. […] The estimation of degree of causality may be underestimated or overestimated in populations with PFO prevalence significantly lower or higher than the established. […] Future large-scale TCD-based studies should investigate potential heterogeneity in PFO prevalence in different healthy racial/ethnic populations.

• #1 Patent foramen ovale – UpToDate

  https://www.uptodate.com/contents/patent-foramen-ovale

  Patent foramen ovale (PFO) is a congenital cardiac lesion that frequently persists into adulthood. Although most patients with a PFO are asymptomatic, a variety of clinical manifestations may be associated with PFO, most importantly cryptogenic stroke. […] PFO was found in 25 to 30 percent of individuals in an autopsy study and in a community-based transesophageal echocardiography (TEE) study. […] Probe-patent PFO was present in 27 percent; the prevalence and size were similar in males and females.

• #1 Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32411074/

  Results: In healthy/control subjects, PFO prevalence was 24.2% (1,872/7,747) in autopsy studies, 23.7% (325/1,369) in TEE, 31.3% (111/355) in TCD, and 14.7% (186/1,267) in TTE studies. All diagnostic modalities included PFO prevalence was higher in CE compared with healthy/control population [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 2.5-3.8] and compared with non-CE (OR = 2.3, 95% CI = 2.0-2.6). In patients with CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (48.9 vs. 27.3%, p0.0001, OR = 2.6 with 95% CI = 2.0-3.3) or TCD (58.1 vs. 41%, OR = 1.9, 95% CI = 1.6-2.5), but not TTE (53.3 vs. 37.5%, p= 0.16). Regarding non-CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (20 vs. 12.9%, OR = 1.7, 95% CI = 1.0-2.8) but not TTE (10.4 vs. 7.8%, p= 0.75) or TCD (22.8 vs. 20.1%, p= 0.56).

• #1 Prevalence and characteristics of patent foramen ovale in a sample of Egyptian population: a computed tomography study | The Egyptian Heart Journal | Full Text

  https://tehj.springeropen.com/articles/10.1186/s43044-024-00504-3

  The reported prevalence of patent foramen ovale (PFO) in the general population is variable. It ranges between 8.6 and 42% according to the population studied and the imaging technique used. […] The prevalence of PFO among the studied population was 16.3%; closed PFO (grade I) 44.2%, open PFO (grade II) 50.9%, and open PFO with jet (grade III) 4.9%. […] The prevalence of PFO in our study was approximately 16.3%, almost half of them showed anatomical high-risk features for stroke. […] There is a need to know the prevalence and anatomical characteristics of PFO in our population as well as its associated clinical manifestations. […] The actual prevalence of PFO in Egypt is not known yet. […] Diagnosis and recognition of PFO would facilitate early intervention, help in improving PFO- and IAS-related manifestations such as stroke, TIA, migraine headache, dizziness and syncope.

• #1 Prevalence of Patent Foramen Ovale in the Japanese Population　– Autopsy Study –

  https://www.jstage.jst.go.jp/article/circj/79/9/79_CJ-15-0197/_article

  Patent foramen ovale (PFO) can cause ischemic stroke because of paradoxical embolism. […] The aim of this study was to clarify the prevalence of PFO in the Japanese population. […] In the database of the Japanese Society of Pathology, the incidence of PFO was 0.08% (43/52,717). […] Inspection of heart specimens disclosed that the prevalence of PFO was 13.6% (14/103). […] PFO is under-reported in autopsy reports. […] The prevalence was lower than reported in the past.

• #1 Patent Foramen Ovale: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/156863-overview

  Patent foramen ovale (PFO) is detected in 10-15% of the population by contrast transthoracic echocardiography. Autopsy studies show a 27% prevalence of probe-patent foramen ovale. […] The prevalence of PFO declines progressively with age34% up to age 30 years, 25% for age 30-80 years, and 20% older than 80 years.

• #1 Patent foramen ovale epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Patent_foramen_ovale_epidemiology_and_demographics

  Approximately 1 in four healthy adults has a patent foramen ovale. The incidence decreases with increasing age, but the size increases with age. It is the most common cardiac finding in people less than 55 years with an unexplained cerebrovascular event. It is prevalent in men and women equally and has no racial predilection. […] The prevalence of patent foramen ovale is approximately 25,000 per 100,000 individuals worldwide. […] It is more common in those under the age of 30 and less common in those above 80 years. […] The incidence of patent foramen ovale varies with age: 0-30 years: 34.3%; 40-80 years: 25.4%; 90+ years: 20.2%. […] Patent foramen ovale size increases with age, from a mean of approximately 3mm in the first decade to approximately 6 mm in the 10th decade of life. […] In patients less than 55 years with an unexplained cerebrovascular event, patent foramen ovale is the most common cardiac finding seen. It is presumed to be caused by a paradoxical emboli. […] There is no racial predilection to patent foramen ovale. […] Patent foramen ovale affects men and women equally.

• #1 Patent Foramen Ovale: Current State of the Art – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-patent-foramen-ovale-current-state-articulo-13124413

  Patent foramen ovale is a congenital cardiac lesion that persists into adulthood and which is present in over 25% of the adult population. […] A review of the available, autopsy-derived data reveals an estimated 25% prevalence of PFO in the adult population. […] Prevalence falls with age and is 20% in patients over 80 years. […] No significant differences have been found in prevalence between men and women. […] Because of the controversy regarding the clinical significance of PFOs, the high prevalence of these lesions, and the variety therapeutic options available, increased attention has been directed towards this condition in the last years. […] The treatment of PFO, especially in patients with cryptogenic infarction, is not defined. […] While we await the results of randomized studies under way at the time of writing, available scientific evidence cannot confirm the superiority of percutaneous/surgical closure over medical treatment (antiplatelet drug/anticoagulant treatment), although some indirect data do support this.

• #1 Management of Patent Foramen Ovale | USC Journal

  https://www.uscjournal.com/articles/update-management-patent-foramen-ovale-2017-indication-closure-and-literature-review?language_content_entity=en

  Patent foramen ovale (PFO) is a common congenital abnormality with a high prevalence of approximately 25 % in the general population and an even higher incidence of about 40 % in the cryptogenic stroke population. […] PFO prevalence in cryptogenic stroke patients is greater (about 40 %) than in the general population, and even higher in cryptogenic stroke patients 55 years of age (about 55 %). […] Multiple studies have established an association between PFO and cryptogenic stroke. […] The Risk of Paradoxical Embolism (RoPE) study devised a predictive model to determine the likelihood of initial stroke being due to the presence of PFO and to predict recurrent stroke risk. […] The American Academy of Neurology recommends the use of a contrast-enhanced TEE for the detection of a PFO and inter-atrial shunting for the potential cause of stroke.

• #1 Patent Foramen Ovale and Cryptogenic Stroke: Integrated Management

  https://www.mdpi.com/2077-0383/12/5/1952

  Patent foramen ovale (PFO) is a common cardiac abnormality with a prevalence of 25% in the general population. PFO has been associated with the paradoxical embolism causing cryptogenic stroke and systemic embolization. Results from clinical trials, meta-analyses, and position papers support percutaneous PFO device closure (PPFOC), especially if interatrial septal aneurysms coexist and in the presence of large shunts in young patients. […] A cryptogenic mechanism seems to be involved in 10–40% of all ischemic strokes. PFO is thought to cause about 50% of cryptogenic strokes. […] Ischemic stroke can be classified by the TOAST classification, the ASCOD phenotyping system and the Causative Classification System. If the full diagnostic work-up results in excluding other etiologies, stroke can be considered cryptogenic.

• #1 Prevalence and characteristics of patent foramen ovale in a sample of Egyptian population: a computed tomography study | The Egyptian Heart Journal | Full Text

  https://tehj.springeropen.com/articles/10.1186/s43044-024-00504-3

  The precise mechanism by which PFO causes a stroke is uncertain. Paradoxical embolism is the most acceptable hypothesis. […] TIA was significantly higher in patients with any IAS abnormalities including PFO compared to those without IAS abnormalities. […] Syncope was significantly higher in patients with PFO compared to those without PFO. […] The prevalence of PFO in the general population is variable, ranging between 8.6 and 42.7%.

• #1 A case of cryptogenic stroke in a young woman with a patent foramen ovale

  https://www1.racgp.org.au/ajgp/2022/june/cryptogenic-stroke-in-a-woman-with-a-patent-forame

  PFOs are very common and are present in up to 25% of adults, although this number reaches 50% in those with classical migraine. […] For adults aged 35-40 years, the incidence of PFO has been measured to be 17%. […] In the absence of significant vascular disease, atrial fibrillation, structural heart disease or thrombotic diathesis, the cryptogenic stroke is most likely due to an embolic event associated with the patients PFO. […] The presence of a hypermobile atrial septum further increases the risk of recurrent strokes. […] An estimated 10% of all ischaemic strokes in young patients aged 55 years are attributable to a PFO, although the incidence of ischaemic stroke in young patients remains low, affecting only eight per 100,000. […] However, PFO remains an important aetiology to consider in cases of cryptogenic stroke, responsible for 42% of cryptogenic strokes in patients aged 55 years and 15% in patients aged 55 years.

• #1 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  The evaluation of PFO relies on a detailed assessment with the use of various diagnostic modalities. In the following section, we discuss various available diagnostic modalities that are routinely used for detailed assessment of cardio-aortic anomalies. […] TCD is an established, cost-effective, and a valid imaging modality for PFO detection. […] TEE remains as the gold standard diagnostic modality for detection of PFO. […] The diagnostic workup in a patient with cryptogenic stroke remains of paramount importance and requires a thorough initial diagnostic workup. All young and middle-aged patients diagnosed with cerebral ischemia should undergo detailed evaluation to identify atherosclerosis in large or small cerebral arteries, nonatherosclerotic arteriopathies, structural and dysrhythmic cardio-aortic sources of embolism, and hypercoagulable states before branding a diagnosis of cryptogenic stroke.

• #1 New guidelines on the diagnosis and management of PFO after stroke – VJNeurology

  https://www.vjneurology.com/video/sw-euiifiwq-new-guidelines-on-the-diagnosis-and-management-of-pfo-after-stroke/

  Valeria Caso, MD, PhD, FESO, from Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy, discusses the new European Stroke Organisation (ESO) guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke. The new guidelines, reflecting the updated state of knowledge in the field, cover diagnosis, treatment, and long-term management of PFO. […] Based on current evidence, no recommendation on the optimal diagnostic tool could be given. […] We divided the guidelines in three parts: one was diagnosis, second was treatment, and long-term management. Regarding diagnosis, we found that based on the rigorous grade system approach we could not give a definite indication of which diagnostic tool has to be used. […] Regarding treatment, we gave a clear indication that patients between 18 and 60 needs to be closed. So if there is a PFO and a stroke, the patient needs to be closed. […] Regarding the long-term management, one of the complication that we have after PFO closure is AF. […] So we stated as an evidence-based recommendation that DAPT (double antiplatelets) should be done for 1-6 months, followed by at least 5 years of single antiplatelet therapy.

• #1 A case of cryptogenic stroke in a young woman with a patent foramen ovale

  https://www1.racgp.org.au/ajgp/2022/june/cryptogenic-stroke-in-a-woman-with-a-patent-forame

  The RoPE score is a 10-point scale used to determine the risk of a PFO being pathogenic in a cryptogenic stroke, and it can also estimate the risk of stroke recurrence in the following two years. […] The patient had a RoPE score of 9, indicating that the risk of the stroke being attributable to her PFO was 88%, with a 2% risk of recurrent cryptogenic stroke in the next two years. […] It is likely that the hypercoagulable state during pregnancy would further increase the risk of PFO-related complications. […] However, despite the higher risk of stroke, the majority of these patients with PFO-associated stroke had good neurological outcomes and uneventful deliveries of healthy newborns. […] For women presenting with stroke in pregnancy, the finding of a PFO would be an indication for anticoagulation. […] The presence of a PFO during pregnancy is of concern and may warrant cardiologist assessment.

• #1 Cerebrovascular Events in Older Patients With Patent Foramen Ovale: Current Status and Future Perspectives

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2023.01599

  Patent foramen ovale (PFO) closure, along with medical therapy, has emerged as the therapeutic gold standard in younger (60-year-old) patients with a PFO-related stroke for preventing recurrent events. […] Several studies have shown a higher prevalence of PFO among older patients with cryptogenic stroke, and its presence has been associated with an increased risk of recurrent events. […] Additionally, observational studies have shown the safety and preliminary efficacy of PFO closure in older PFO-related stroke patients. […] Yet, higher rates of recurrent cerebrovascular events and new-onset atrial fibrillation were observed in some studies among older patients compared to their younger counterparts. […] Ongoing trials will provide important insights into the role of PFO closure in the elderly population.

• #1 Patent Foramen Ovale Closure in Special Clinical Situations: More Questions Than Answers?

  https://www.mdpi.com/2075-1729/14/6/706

  A causal relationship between PFO and cryptogenic stroke through paradoxical thromboembolism has been established, with PFO-associated stroke representing about 10% of ischemic strokes in patients under 60 years old. […] The purpose of our review is to summarise the current knowledge regarding epidemiology, pathophysiology, and the role of closure on these patients to help clinicians in the decision-making process and tailored approach. […] While the association between PFO and cryptogenic stroke in patients under 60 years old has been established, evidence suggests that PFO also demonstrates a link with cryptogenic stroke in older patient groups. […] The management of patients >60 years old with a cryptogenic stroke and a PFO remains controversial, as current RCTs excluded this age group. […] The current guidelines for managing PFO lack definite recommendations for older patients with cryptogenic stroke.

• #1 Prevalence of Patent Foramen Ovale in Ischemic Stroke Patients Over 60 Years of Age

  https://www.scivisionpub.com/articles/prevalence-of-patent-foramen-ovale-in-ischemic-stroke-patients-over-60-years-of-age-2786.html

  The patent foramen oval (PFO) prevalence is higher in young subjects with cryptogenic stroke compared to the general population, but there is not much information in subjects over 60 years old. […] The goal of this study is to estimate the prevalence of PFO in patients over 60 years of age managed at Centre hospitalier intercommunal de Poissy/Saint Germain en Laye (CHIPS) for an acute ischemic stroke (AIS) and compare these results to what has already been reported in the literature. […] In our series, we have a significant PFO prevalence of 12.5% in cryptogenic AIS (1 in 8 cryptogenic AIS), which corresponds to the prevalence reported in the literature in subjects over 60 years of age with cryptogenic AIS (13%). […] Before randomized studies evaluating the efficacy of PFO- closure in subjects over 60 years, it is necessary to demonstrate the association between PFO and cryptogenic AIS in this age group.

• #1 Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32411074/

  Conclusions: Given the limitations of autopsy and TEE studies, there is good reason not to take a fixed 25% PFO prevalence for granted. The estimation of degree of causality may be underestimated or overestimated in populations with PFO prevalence significantly lower or higher than the established. Given the high sensitivity, non-invasive nature, low cost, and repeatability of TCD, future large-scale TCD-based studies should investigate potential heterogeneity in PFO prevalence in different healthy racial/ethnic populations.

• #1

  https://journals.lww.com/neur/fulltext/2022/70030/prevalence_of_patent_foramen_ovale_in_north_indian.38.aspx

  In our study, on young ischemic CS of north Indians, the prevalence of RLS (likely secondary to PFO), by bubble contrast, TCD was 31.6%. […] The prevalence of PFO in healthy controls in our study population was 6%. […] Currently, no published data on the prevalence of PFO in CS and a healthy Indian population is available. […] In conclusion, the prevalence of TCD positive RLS is high in north Indian young CS and TCD with bubble contrast is a feasible and pragmatic evaluation to detect RLS in these patients.

• #1 Establishment of the Heart and Brain Team for Patent Foramen Ovale Closure in Stroke Patients: An Expert Opinion

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2022.02103

  The online 2021 Asian-Pacific Heart and Brain Summit was organized to present and discuss experiences within leading Asian-Pacific centers with regard to institutional heart and brain teams managing the diagnosis, treatment, and follow-up of cryptogenic stroke (CS) patients with patent foramen ovale (PFO). […] Guidelines and consensus statements emphasize the importance of multidisciplinary clinical decision-making regarding PFO closure with the involvement of several clinical specialties, including neurology, cardiology, and hematology. […] The heart and brain team is a collaborative platform that facilitates such a multidisciplinary decision-making process and patient involvement. […] A heart and brain team is a multidisciplinary collaboration platform that facilitates an individualized decision-making process with equitable involvement of all relevant clinical specialties.

• #1 Establishment of the Heart and Brain Team for Patent Foramen Ovale Closure in Stroke Patients: An Expert Opinion

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2022.02103

  Guidelines and consensus documents have emphasized the importance of the involvement of multiple clinical disciplines and the patient in decision-making regarding PFO closure. […] The heart and brain team is a multidisciplinary collaboration involving several clinical specialties who manage and coordinate various healthcare aspects regarding CS and PFO closure. […] A comprehensive stroke workup is a prerequisite for the heart and brain team in the diagnosis and decision-making associated with the potential diagnosis of CS and consequent consideration of PFO closure. […] The term PFO-associated stroke has been proposed as a distinct entity of ischemic stroke for all patients presenting with superficial, large deep, or retinal infarcts in the presence of a medium-to high-risk PFO and no other identified causes.

• #1 Establishment of the Heart and Brain Team for Patent Foramen Ovale Closure in Stroke Patients: An Expert Opinion

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2022.02103

  The heart and brain team plays an important role in patient engagement and education. […] The establishment of a heart and brain team requires extensive networking between relevant specialties, some of which may not consider PFO closure as an option for stroke prevention after CS. […] The heart and brain team should consider developing a standard operating procedure to describe evidence-based decision-making within the team. […] This collaboration has been proposed in the literature and is supported by guidelines and consensus statements.

• #1 Cerebrovascular Events in Older Patients With Patent Foramen Ovale: Current Status and Future Perspectives

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2023.01599

  The authors extrapolated their results amongst the British population, estimating that every year 8,477 cryptogenic cerebral ischemic events could be attributed to significant right-to-left shunting, with 70% of them occurring in patients older than 60 years. […] Identifying these high-risk PFO features is crucial since there is potentially a higher benefit from PFO closure among patients with high-risk anatomical PFO features. […] The risk of paradoxical embolism (RoPE) score allows an evaluation of the potential causal role of a PFO in any given patient with a stroke of unknown cause. […] According to meta-analyses, patients with a PFO-related stroke, the annual recurrence rate on medical therapy ranges from 0% to 5.8% for stroke and from 0% to 14% for stroke or TIA. […] Remarkably, compared to younger patients, elderly patients are at higher risk of recurrent cryptogenic stroke after an index PFO-related event.

• #1 Management of Patent Foramen Ovale | USC Journal

  https://www.uscjournal.com/articles/update-management-patent-foramen-ovale-2017-indication-closure-and-literature-review?language_content_entity=en

  Based on the results of three completed clinical trials, the recurrence rate of ischemic stroke in patients with PFO and medically-treated cryptogenic stroke ranges between 0.6 % and 1.5 % per year. […] Despite medical therapy, the stroke recurrence rate in ischemia stroke patients with PFO is estimated at 4.5 % within a 4-year period. […] Observational data, including meta-analysis of observational studies on PFO closure therapy, point to the safety and low stroke recurrence rate compared to medical treatment alone. […] These three trials have shown exciting, encouraging and compelling evidence that PFO closure reduces the risk of recurrent stroke and provide strong supportive data for the ongoing debate on PFO closure in cryptogenic stroke.

• #1 Closure or medical therapy of patent foramen ovale in cryptogenic stroke: prospective case series | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00114-3

  Recent RCT and epidemiological studies have yielded progress with regard to causal attribution of PFO to IS/TIA, and the decision pro/con PFO-closure. […] Our objective was to compare PFO-closure to secondary prevention with MTA in cryptogenic IS/TIA patients below and above 60 years. […] In high-risk PFO patients 60 years who underwent PFO-closure, annual IS recurrence rate was 1.0%. […] The 20 high-risk PFO patients 60 years who received MTA (all crossovers) had similar RoPE scores compared to the 103 high-risk PFO patients 60 years who underwent PFO-closure. […] When comparing high-risk PFO patients 60 years who underwent PFO-closure with those high-risk PFO patients 60 years receiving MTA, the higher age of the latter, combined with higher rates of diabetes and history of smoking, well explains lower RoPE scores in this group.

• #2 Patent Foramen Ovale and Cryptogenic Stroke: Integrated Management

  https://www.mdpi.com/2077-0383/12/5/1952

  Patent foramen ovale (PFO) is a common cardiac abnormality with a prevalence of 25% in the general population. PFO has been associated with the paradoxical embolism causing cryptogenic stroke and systemic embolization. Results from clinical trials, meta-analyses, and position papers support percutaneous PFO device closure (PPFOC), especially if interatrial septal aneurysms coexist and in the presence of large shunts in young patients. […] A cryptogenic mechanism seems to be involved in 10–40% of all ischemic strokes. PFO is thought to cause about 50% of cryptogenic strokes. […] Ischemic stroke can be classified by the TOAST classification, the ASCOD phenotyping system and the Causative Classification System. If the full diagnostic work-up results in excluding other etiologies, stroke can be considered cryptogenic.

• #2 Cerebrovascular Events in Older Patients With Patent Foramen Ovale: Current Status and Future Perspectives

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2023.01599

  However, observational data have shown a higher prevalence of PFO among older patients diagnosed with cryptogenic stroke, and the presence of PFO in the elderly population has been associated with an increased risk of recurrent cerebrovascular events. […] This review provides an overview of the epidemiology of ischemic stroke in the elderly, particularly cardioembolic and PFO-related stroke. […] The prevalence of PFO differs according to patients age, from 34.3% during the first three decades of life to 20.2% during the 9th and 10th decades. […] The spontaneous closure of foramen ovale usually occurs within the first year of life but only in three-fourths of the population, leaving approximately 25% of the adult population with a PFO, which translates to about 1.9 billion people globally.

• #2 Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32411074/

  Results: In healthy/control subjects, PFO prevalence was 24.2% (1,872/7,747) in autopsy studies, 23.7% (325/1,369) in TEE, 31.3% (111/355) in TCD, and 14.7% (186/1,267) in TTE studies. All diagnostic modalities included PFO prevalence was higher in CE compared with healthy/control population [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 2.5-3.8] and compared with non-CE (OR = 2.3, 95% CI = 2.0-2.6). In patients with CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (48.9 vs. 27.3%, p0.0001, OR = 2.6 with 95% CI = 2.0-3.3) or TCD (58.1 vs. 41%, OR = 1.9, 95% CI = 1.6-2.5), but not TTE (53.3 vs. 37.5%, p= 0.16). Regarding non-CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (20 vs. 12.9%, OR = 1.7, 95% CI = 1.0-2.8) but not TTE (10.4 vs. 7.8%, p= 0.75) or TCD (22.8 vs. 20.1%, p= 0.56).

• #2 Patent foramen ovale epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Patent_foramen_ovale_epidemiology_and_demographics

  Approximately 1 in four healthy adults has a patent foramen ovale. The incidence decreases with increasing age, but the size increases with age. It is the most common cardiac finding in people less than 55 years with an unexplained cerebrovascular event. It is prevalent in men and women equally and has no racial predilection. […] The prevalence of patent foramen ovale is approximately 25,000 per 100,000 individuals worldwide. […] It is more common in those under the age of 30 and less common in those above 80 years. […] The incidence of patent foramen ovale varies with age: 0-30 years: 34.3%; 40-80 years: 25.4%; 90+ years: 20.2%. […] Patent foramen ovale size increases with age, from a mean of approximately 3mm in the first decade to approximately 6 mm in the 10th decade of life. […] In patients less than 55 years with an unexplained cerebrovascular event, patent foramen ovale is the most common cardiac finding seen. It is presumed to be caused by a paradoxical emboli. […] There is no racial predilection to patent foramen ovale. […] Patent foramen ovale affects men and women equally.

• #2 Patent Foramen Ovale (PFO) Closure: Procedure & Indications

  https://www.icrjournal.com/articles/patent-foramen-ovale-closure-state-art?language_content_entity=en

  Patent foramen ovale (PFO) is a common abnormality affecting between 20% and 34% of the adult population. […] Recent randomised control trials have demonstrated that closure of PFO in patients with cryptogenic stroke is associated with reduced rates of recurrent stroke. […] The cause of stroke remains unknown in up to 40% of patients with a stroke diagnosis. These are designated as cryptogenic stroke. In the presence of a PFO, the presumed cause of stroke is paradoxical embolus. […] Nonetheless, further randomised trials learned lessons from earlier neutral studies and have demonstrated that PFO closure is superior to medical therapy for the prevention of recurrent stroke. […] Meta-analyses of these trials confirm that PFO closure reduces the risk of ischaemic stroke in patients with a PFO and cryptogenic stroke.

• #2 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  Patent foramen ovale (PFO) is prevalent in one-quarter of all adults and is the most common cause of right-to-left shunt (RLS). Annually, ~18,000 patients between 18 to 60 years of age living in the United States and 345,000 worldwide are diagnosed with a PFO and an embolic stroke of otherwise undetermined source (ESUS). ESUS represents a substantial portion of cryptogenic ischemic strokes that may have paradoxical embolism due to PFO as an underlying etiology. PFO is prevalent in one half of patients with cryptogenic stroke, and one-half of those PFOs are causative for ischemic strokes. […] Multiple randomized-controlled clinical trials (RCTs), earlier trials in 2012 to 2013, followed by in 2017 to 2018 have transformed the diagnostic and therapeutic management for cryptogenic stroke patients diagnosed with PFO. However, various available diagnostic modalities continue to pose clinical dilemma for clinicians during the management of cryptogenic ischemic stroke patients.

• #2 Patent foramen ovale and cryptogenic stroke: diagnosis and updates in secondary stroke prevention | Stroke and Vascular Neurology

  https://svn.bmj.com/content/3/2/84

  The patent foramen ovale (PFO), given its high prevalence in the general population and especially in patients with cryptogenic stroke, has long generated investigation and debate on its propensity for stroke by paradoxical embolism and its management for stroke prevention. […] PFO prevalence is up to 40% in patients with cryptogenic stroke, suggesting that it may be conduit for stroke caused by paradoxical embolism rather than just an incidental finding. […] The opportunity for risk stratification and secondary stroke prevention in this cohortcryptogenic stroke with PFOunderscored a number of randomised controlled trials (RCT) leading to a Food and Drug Administration (FDA) approval of the Amplatzer PFO Occluder in October 2016. […] A number of studies have examined the clinical clues that predict PFOs propensity for paradoxical embolism.

• #2 Patent foramen ovale and cryptogenic stroke: diagnosis and updates in secondary stroke prevention | Stroke and Vascular Neurology

  https://svn.bmj.com/content/3/2/84

  High-risk features of PFO that increase its risk for causing paradoxical embolism can be detected with high sensitivity and specificity with TEE and TCD. […] Percutaneous PFO closure is beneficial and relatively safe for secondary stroke prevention among adults 60 years, with few conventional vascular risk factors, who have undergone a thorough work-up of their stroke aetiology and are deemed cryptogenic except for the presence of PFO, and who may have large shunts or associated ASA.

• #2 Patent foramen ovale and cryptogenic stroke: diagnosis and updates in secondary stroke prevention | Stroke and Vascular Neurology

  https://svn.bmj.com/content/3/2/84

  The data on shunt size and risk of stroke have been nebulous: while some studies suggest larger shunt increases the risk of stroke, others note no difference based on shunt size. […] Recent RCTs have included variables such as large shunt size and associated ASA; however, the verdict on how PFO closure affects those with large shunt size is incongruent among RESPECT (Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment) (those with ASA and large shunts fare better), […] A meta-analysis by Almekhlafi et al found that recurrent stroke or TIA rates of cryptogenic stroke with PFO did not increase compared with cryptogenic stroke without PFO (relative risk (RR)=1.1, 95%CI 0.8 to 1.5). […] The difficulty with attributing PFO as the actual cause of stroke has led to the development of the Risk of Paradoxical Embolism (RoPE) score in cryptogenic stroke, drawing from a database of 3023 patients with cryptogenic stroke who had PFO studied by TEE or TCD, where cryptogenic stroke was defined by the Trial of Org 10172 for Acute Stroke Treament (TOAST) classification.

• #2 European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism | EuroIntervention

  https://eurointervention.pcronline.com/article/european-position-paper-on-the-management-of-patients-with-patent-foramen-ovale-general-approach-and-left-circulation-thromboembolism

  PFO has been associated with left circulation thromboembolism to several organs; therefore we promote the use of standardised definitions. […] The management we propose in this paragraph applies to systemic thromboembolism as well as to all PFO-associated syndromes. […] In all clinical scenarios, the two main axes guiding assessment and treatment of PFO should be: 1) the probability that any PFO has a relevant role in the observed clinical picture; 2) the likelihood that the observed clinical event will recur. […] The risk of paradoxical embolism (RoPE) score represents an attempt to assign a causal relationship probability to individual PFOs in the setting of stroke of unknown cause and may be useful in helping to guide management decisions. […] The management of patients with cryptogenic left circulation thromboembolism and PFO has been controversial, giving rise to heterogeneous strategies across different local realms in Europe.

• #2 Patent Foramen Ovale Closure in Special Clinical Situations: More Questions Than Answers?

  https://www.mdpi.com/2075-1729/14/6/706

  A causal relationship between PFO and cryptogenic stroke through paradoxical thromboembolism has been established, with PFO-associated stroke representing about 10% of ischemic strokes in patients under 60 years old. […] The purpose of our review is to summarise the current knowledge regarding epidemiology, pathophysiology, and the role of closure on these patients to help clinicians in the decision-making process and tailored approach. […] While the association between PFO and cryptogenic stroke in patients under 60 years old has been established, evidence suggests that PFO also demonstrates a link with cryptogenic stroke in older patient groups. […] The management of patients >60 years old with a cryptogenic stroke and a PFO remains controversial, as current RCTs excluded this age group. […] The current guidelines for managing PFO lack definite recommendations for older patients with cryptogenic stroke.

• #2 Prevalence of Patent Foramen Ovale in Ischemic Stroke Patients Over 60 Years of Age

  https://www.scivisionpub.com/articles/prevalence-of-patent-foramen-ovale-in-ischemic-stroke-patients-over-60-years-of-age-2786.html

  The association between cryptogenic acute ischemic stroke (AIS) and patent foramen ovale (PFO) is clearly established in the literature for subjects under 60 years of age, with a PFO prevalence of 40% compared to 25% in the general population, but there is not much information in subjects over 60 years old. […] A few studies have addressed this issue, but their results are inconsistent. […] The prevalence of large PFO in the elderly is reported to be 13%. […] Thus, the association between PFO and cryptogenic AIS seems to persist beyond the age of 60 in some studies. […] Our study is not a comparative study since we excluded patients with a known cause (apart from a cardio-embolic cause on A-FIB). […] Our aim was to make an initial estimate of the presence of PFO in our elderly patients treated at CHIPS before conducting further studies on the subject.

• #2 Establishment of the Heart and Brain Team for Patent Foramen Ovale Closure in Stroke Patients: An Expert Opinion

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2022.02103

  Guidelines and consensus documents have emphasized the importance of the involvement of multiple clinical disciplines and the patient in decision-making regarding PFO closure. […] The heart and brain team is a multidisciplinary collaboration involving several clinical specialties who manage and coordinate various healthcare aspects regarding CS and PFO closure. […] A comprehensive stroke workup is a prerequisite for the heart and brain team in the diagnosis and decision-making associated with the potential diagnosis of CS and consequent consideration of PFO closure. […] The term PFO-associated stroke has been proposed as a distinct entity of ischemic stroke for all patients presenting with superficial, large deep, or retinal infarcts in the presence of a medium-to high-risk PFO and no other identified causes.

• #2 Establishment of the Heart and Brain Team for Patent Foramen Ovale Closure in Stroke Patients: An Expert Opinion

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2022.02103

  The heart and brain team plays an important role in patient engagement and education. […] The establishment of a heart and brain team requires extensive networking between relevant specialties, some of which may not consider PFO closure as an option for stroke prevention after CS. […] The heart and brain team should consider developing a standard operating procedure to describe evidence-based decision-making within the team. […] This collaboration has been proposed in the literature and is supported by guidelines and consensus statements.

• #2 Patent Foramen Ovale (PFO): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17326-patent-foramen-ovale-pfo

  Patent foramen ovale affects about 25% of people worldwide. PFO impacts about 30% to 40% of people whove had an unexplained stroke. This does not mean that everyone who has PFO will experience a stroke or mini-stroke. […] Most people with patent foramen ovale wont need treatment. But your provider may recommend treatment if you have a history or high risk of strokes or blood clots. Treatments for PFO include: […] Recent research suggests that PFO closure may help prevent future strokes in people with PFO whove had an unexplained stroke.

• #2 Cerebrovascular Events in Older Patients With Patent Foramen Ovale: Current Status and Future Perspectives

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2023.01599

  The most recent evidence on recurrent events was reported by Mazzucco et al. […] The causal relationship between a PFO and a stroke among elderly patients was once thought to be lower as the incidence of stroke due to other causes increased. […] Nevertheless, this causal association may be higher than expected. […] Overall, the mean incidence of recurrent stroke events following PFO closure in older patients has been about 1.38 per 100 patients-years, which appears to be lower than 3.27 per 100 patient-years, which is the reported incidence of recurrent cerebrovascular events in studies of older patients with PFO treated medically. […] A potential approach for PFO closure candidates older than 55-65 years with no history of AF could be an implantable loop recorder 6 months before the procedure and systematic midterm monitoring for arrhythmia detection and its corresponding treatment.

• #2 Cerebrovascular Events in Older Patients With Patent Foramen Ovale: Current Status and Future Perspectives

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2023.01599

  Patent foramen ovale (PFO) closure, along with medical therapy, has emerged as the therapeutic gold standard in younger (60-year-old) patients with a PFO-related stroke for preventing recurrent events. […] Several studies have shown a higher prevalence of PFO among older patients with cryptogenic stroke, and its presence has been associated with an increased risk of recurrent events. […] Additionally, observational studies have shown the safety and preliminary efficacy of PFO closure in older PFO-related stroke patients. […] Yet, higher rates of recurrent cerebrovascular events and new-onset atrial fibrillation were observed in some studies among older patients compared to their younger counterparts. […] Ongoing trials will provide important insights into the role of PFO closure in the elderly population.

• #3 Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32411074/

  Results: In healthy/control subjects, PFO prevalence was 24.2% (1,872/7,747) in autopsy studies, 23.7% (325/1,369) in TEE, 31.3% (111/355) in TCD, and 14.7% (186/1,267) in TTE studies. All diagnostic modalities included PFO prevalence was higher in CE compared with healthy/control population [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 2.5-3.8] and compared with non-CE (OR = 2.3, 95% CI = 2.0-2.6). In patients with CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (48.9 vs. 27.3%, p0.0001, OR = 2.6 with 95% CI = 2.0-3.3) or TCD (58.1 vs. 41%, OR = 1.9, 95% CI = 1.6-2.5), but not TTE (53.3 vs. 37.5%, p= 0.16). Regarding non-CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (20 vs. 12.9%, OR = 1.7, 95% CI = 1.0-2.8) but not TTE (10.4 vs. 7.8%, p= 0.75) or TCD (22.8 vs. 20.1%, p= 0.56).

• #3 Patent Foramen Ovale and Cryptogenic Stroke: Integrated Management

  https://www.mdpi.com/2077-0383/12/5/1952

  The term “PFO-associated stroke” has been proposed to indicate a distinct causative mechanism of ischemic stroke, which may be used after a comprehensive patient evaluation. If superficial, large, deep, or retinal infarcts occur in patients with a medium- to high-risk PFO without other demonstrated causative factors, we can name the event a PFO-associated stroke.

• #3 Cerebrovascular Events in Older Patients With Patent Foramen Ovale: Current Status and Future Perspectives

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2023.01599

  Ongoing clinical trials addressing the recurrence of AF among older patients undergoing PFO closure will provide definitive insights on this important confounder among the elderly population with PFO and a cryptogenic stroke. […] Although some data suggest that transcatheter PFO closure is effective in older patients with a PFO-associated stroke, there are still several gaps in the evidence, namely the absence of specific randomized clinical trials in such patients. […] Therefore, a thorough multidisciplinary case-by-case evaluation is warranted to define the best treatment option for older patients with high-risk PFO-related stroke.

• #4 Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32411074/

  Results: In healthy/control subjects, PFO prevalence was 24.2% (1,872/7,747) in autopsy studies, 23.7% (325/1,369) in TEE, 31.3% (111/355) in TCD, and 14.7% (186/1,267) in TTE studies. All diagnostic modalities included PFO prevalence was higher in CE compared with healthy/control population [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 2.5-3.8] and compared with non-CE (OR = 2.3, 95% CI = 2.0-2.6). In patients with CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (48.9 vs. 27.3%, p0.0001, OR = 2.6 with 95% CI = 2.0-3.3) or TCD (58.1 vs. 41%, OR = 1.9, 95% CI = 1.6-2.5), but not TTE (53.3 vs. 37.5%, p= 0.16). Regarding non-CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (20 vs. 12.9%, OR = 1.7, 95% CI = 1.0-2.8) but not TTE (10.4 vs. 7.8%, p= 0.75) or TCD (22.8 vs. 20.1%, p= 0.56).

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