Wu Lambert A, Malouf Joseph F, Dearani Joseph A, Hagler Donald J, Reeder Guy S, Petty George W, Khandheria Bijoy K
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Arch Intern Med. 2004 May 10;164(9):950-6. doi: 10.1001/archinte.164.9.950.
There is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalva-inducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.
卵圆孔未闭（PFO）与原因不明的确诊卒中（通常称为隐源性卒中）之间的关联越来越受到关注。我们回顾了文献，并基于现有数据为患有PFO和隐源性卒中的患者设计了一种诊断和治疗算法。卵圆孔未闭在普通人群中相对常见，但在隐源性卒中患者中的患病率更高。重要的是，对于年轻的隐源性卒中患者，应强烈考虑通过PFO发生反常栓塞。对于最佳管理策略尚无共识，但治疗选择包括抗血小板药物、华法林钠、经皮装置封堵和手术封堵。患者病史中的高危特征（即瓦尔萨尔瓦动作与卒中之间的时间关联、并存的高凝状态、复发性卒中，以及伴有大开口、大量右向左分流或静息时右向左分流的PFO，以及并存的房间隔瘤）应促使进行PFO封堵。
