Anatomical features of percutaneously closed patent foramen ovale in patients with cryptogenic stroke

Patent foramen ovale (PFO) is increasingly recognized as a cause of stroke, with a prevalence of approximately 25% in the general population. Consequently, the likelihood of encountering a 'bystander PFO' in young patients who have experienced a stroke seems significant. To aid in identifying patients with a PFO-related cryptogenic stroke, an interdisciplinary Heart-Stroke Team (HST) has been established. This team evaluates patients who have suffered from stroke and were diagnosed with a PFO to assess its potential contribution. Understanding the anatomical features of PFOs associated with stroke is essential for decision-making. This study examines the PFO characteristics of all patients who underwent percutaneous PFO closure for cryptogenic stroke at two congenital heart disease institutions in the Netherlands. Data on all patients who underwent PFO closure from 2016 to 2022 were collected. Anatomical characteristics were measured using transesophageal echocardiography and analyzed by two cardiologists. In total, 223 patients underwent PFO closure. The mean age was 42.8 ± 10.7 years, with 115 (51.6%) being male. Approximately 80% of all patients had at least one risk-enhancing PFO feature (moderate to severe shunt and/or atrial septal aneurysm of > 10 mm). Although all patients accepted for percutaneous PFO closure were individually assessed by a dedicated HST, 20% had a PFO without risk-enhancing features but were still accepted for closure due to other reasons. This highlights the importance of careful individual assessment of young stroke patients with a PFO. Future studies are needed to identify the characteristics that contribute to stroke in these patients.