Patent foramen ovale: thromboembolic structure or incidental finding?

A patent foramen ovale (PFO) is identified in approximately 27% of healthy individuals undergoing routine autopsy and in 25% of the general population on transesophageal echocardiography (TEE). PFO generally considered benign, but has been associated with stroke, migraine and diving decompression sickness. We searched Pubmed for English language articles that examined the relationship of PFO to vascular events. PFOs are highly prevalent in patients with cryptogenic stroke and in patients with migraine, but the incidence of primary and recurrent stroke does not seem to be increased in patients with PFO. Consequently, neither anticoagulation nor antiplatelet drugs are recommended in asymptomatic patients lacking other indications for anticoagulation. In symptomatic patients with PFO, current guidelines consider antiplatelet medications as treatment of choice for cerebrovascular events. There is no strong evidence that supports routine closure of PFO in patients with stroke or migraine although some patients with combined characteristics of PFO might benefit from closure. In conclusion, this review suggests that PFO is not an established risk factor for stroke even in the young population with recurrent cryptogenic stroke.