The interest of surgical closure of patent foramen ovale after stroke: a preliminary open study of 8 cases.
The risk of stroke and the risk of recurrent strokes in patients with patent foramen ovale (PFO) need a prevention that still remains a therapeutic problem. There are 4 preventive treatments: anti-agregants, anti-coagulants, transcatheter closure, and surgical closure of PFO. The aim of this study was to demonstrate that surgical closure of PFO is safe and useful for prevention of strokes. Eight patients with stroke and PFO diagnosed by transesophageal echography (TEE) were prospectively selected for surgical closure. It was necessary to be younger than 70 years, not to have another cause of stroke, and to have either recurrent strokes or several ischemic lesions on MRI, isolated for PFO associated with an atrial septal aneurysm, and to have a Valsalva maneuver or cough inducing the stroke. For these reasons, these patients were considered to be an homogenous group with a strong relationship between the PFO and the stroke, and with a high risk of recurrence of stroke. The 8 patients had a direct suture of the PFO with a cardiopulmonary bypass. All patients were followed-up with clinical, MRI and TEE examinations during 12 months after surgery. No surgical complications were observed. After one year, without any anticoagulant treatment, no recurrent stroke or transient ischemic attack, no new ischemic lesions on MRI, nor neuropsychological disturbance were noted. No post-surgical inter-atrial right-to-left shunting was observed. In the absence of controlled studies to guide therapeutic options, our data suggest that surgical closure of PFO in patients with stroke, is safe and efficacious to prevent recurrent stroke without any anticoagulants in the first year of follow-up. Further studies are needed to evaluate the long-term role of surgical closure of PFO as an alternative to prolonged anti-thrombotic treatment.
Giroud
M
M
Service des Neurologie, Centre Hospitalo-Universitaire, Dijon, France.
Tatou
E
E
Steinmetz
E
E
Lemesle
M
M
Cottin
Y
Y
Wolf
J E
JE
Moreau
T
T
David
M
M
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009424:Nervous System Physiological Phenomena; D011446:Prospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome