Patent Foramen Ovale Closure, A Contemporary Review

The patent foramen ovale (PFO) is a common anatomical variant with a prevalence of 25-30%. It may go unnoticed or become symptomatic in terms of systemic embolism (mostly cerebral), migraine, or hypoxemia. Various diagnostic methods exist. Transesophageal echocardiography remains the gold standard. Some echocardiographic criteria allow us to quantify the PFO's risk of paradoxical embolism such as the presence of a large shunt or an associated atrial septal aneurysm. Percutaneous closure of the PFO remains controversial although percutaneous septal occluders were introduced in 1975, 2 years before the first coronary angioplasty. Various observational and randomized studies have unsuccessfully attempted to prove a significant superiority of percutaneous PFO closure compared to drug treatment until the data of long-term follow-up of RESPECT and results of CLOSE and Gore REDUCE made things unequivocally clear in favor of PFO closure.