title: Is the patent foramen ovale closure the best option?
abstract: Patent foramen ovale (PFO) closure is indicated in some cases to protect patients against embolic events. The aim of this study was to certify that the method of PFO closure to prevent microemboli (MES) is reliable, using contrast enhanced transcranial Doppler (cTCD) as a diagnostic and follow-up tool.
  
  
  METHODS
  cTCD was performed before and after PFO closure in 20 patients. Results obtained a minimum of 12 months after the procedure were analyzed in this study.
  
  
  RESULTS
  After the procedure, 14 patients (82%) showed no microemboli in cTCD at rest, but after provocative Valsalva maneuver (VM) microembolic phenomenon were still detected in 14 (70%): 7 (35%) <10 MES, 3 (15%) 10-20 MES and 4 (20%) had more than 20 MES ("curtain"). Only six of the total patients presented no MES in both resting and VM.
  
  
  CONCLUSIONS
  These results showed a large percentage of patients with MES detection in a bubble study with transcranial Doppler more than one year after the procedure of PFO closure, showing right-to-left residual shunting. Despite the small number of patients, this study provides important data about this therapeutic decision.
authors.affiliation: Hospital de Clínicas, Neurology Division, Federal University of Paraná (UFPR), Curitiba PR, Brazil. viviane.zetola@gmail.com
authors.forename: Viviane Flumignan
authors.initials: VF
authors.lastname: Zetola
authors.forename: Melissa Castello Branco e
authors.initials: MC
authors.lastname: Silva
authors.forename: Marcos Christiano
authors.initials: MC
authors.lastname: Lange
authors.forename: Juliano Andre
authors.initials: JA
authors.lastname: Muzzio
authors.forename: Edison Matos
authors.initials: EM
authors.lastname: Novak
authors.forename: Admar
authors.initials: A
authors.lastname: Moraes
authors.forename: Lineu Cesar
authors.initials: LC
authors.lastname: Werneck
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000150:complications / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014636:Valsalva Maneuver