title: PFO: Button me up, but wait … Comprehensive evaluation of the patient.
abstract: Patent foramen ovale (PFO) is a slit or tunnel-like communication in the atrial septum occurring in approximately 25% of the population. A wide number of pathological conditions have been linked to its presence, most notably, cryptogenic stroke (CS) and migraine. However, in the setting of a neurological event, it is not often clear whether the PFO is pathogenically related to the index event or an incidental finding. Therefore, a detailed analysis of several clues is needed for understanding PFO's clinical significance, with a frequent case-by-case decision about destination therapy. Indeed, the controversy about PFO's pathogenicity prompted a paradigm shift of research interest from medical therapy with antiplatelets or anticoagulants to percutaneous transcatheter closure, in secondary prevention. Observational data and meta-analysis of observational studies had previously suggested that PFO closure with a device was a safe procedure with a low recurrence rate of stroke. To date, however, recent randomized controlled trials have not shown the superiority of PFO closure over medical therapy. Thus, the optimal strategy for secondary prevention of paradoxical embolism in patients with a PFO remains unclear. Moreover, the latest guidelines for the prevention on stroke restricted indications for PFO closure to patients with deep vein thrombosis and high-risk of its recurrence. Given these recent data, in the present review, we critically discuss current treatment options, pointing out the role of a comprehensive patient evaluation in overcoming PFO closure restrictions and planning the best management for each patient.
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Pizzino
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA.
authors.forename: Bijoy
authors.initials: B
authors.lastname: Khandheria
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cusmà-Piccione
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Todaro
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
authors.forename: Lilia
authors.initials: L
authors.lastname: Oreto
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Vizzari
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy. Electronic address: publishing160@aurora.org.
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D054087:Atrial Septum / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D019320:Embolism, Paradoxical / Q000209:etiology / Q000517:prevention & control; D054092:Foramen Ovale, Patent / Q000150:complications / Q000628:therapy*; D006801:Humans; D008881:Migraine Disorders / Q000209:etiology; D018579:Patient Selection; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000209:etiology
chemical_list: D000925:Anticoagulants
keywords: Cryptogenic stroke; Device; Patent foramen ovale; Transcatheter closure