Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Expert Rev Cardiovasc Ther. 2021 Mar;19(3):211-220. doi: 10.1080/14779072.2021.1878026. Epub 2021 Feb 19.
: A patent foramen ovale (PFO) is highly prevalent among the adult population. It allows shunting of blood through the inter-atrial septum and has been associated with cryptogenic stroke, transient ischemic attack, platypnea-orthodeoxia syndrome, decompression sickness (e.g. deep-water divers), and migraines.: In this manuscript, we will review the anatomy of PFO with particular emphasis on the factors associated with increased risk of paradoxical embolization, as well as the different modalities for the diagnosis of PFO. We will discuss medical, surgical, and transcatheter therapy for secondary prevention in patients with PFO and cryptogenic stroke, and summarize the data from observational studies, randomized controlled trials (RCTs), and meta-analysis of RCTs that have established the beneficial effect of transcatheter PFO closure in this patient population. Finally, we will provide a brief overview of the role of transcatheter PFO closure in patients with migraine.: Transcatheter closure is the preferred treatment option in young (<60 years) patients with PFO and cryptogenic stroke. A multi-disciplinary approach with input from clinical cardiologist, neurologist, hematologist, cardiac surgeon, and interventional cardiologist provides the best therapeutic plan for each patient taking into account the available data, but also medical, social, and occupational considerations.
卵圆孔未闭（PFO）在成年人群中高度普遍。它允许血液通过房间隔分流，并与隐源性卒中、短暂性脑缺血发作、反常性呼吸困难-直立性低氧血症综合征、减压病（例如深水潜水员）和偏头痛有关。在本文中，我们将回顾 PFO 的解剖结构，特别强调与反常栓塞风险增加相关的因素，以及诊断 PFO 的不同方式。我们将讨论 PFO 和隐源性卒中患者二级预防的药物、手术和经导管治疗，并总结观察性研究、随机对照试验（RCT）和 RCT 荟萃分析的数据，这些数据证实了经导管 PFO 封堵术在这一患者群体中的有益效果。最后，我们将简要概述经导管 PFO 封堵术在偏头痛患者中的作用。对于年轻（<60 岁）的 PFO 和隐源性卒中患者，经导管封堵是首选治疗方法。临床心脏病专家、神经科医生、血液科医生、心脏外科医生和介入心脏病专家的多学科方法，根据可用数据为每位患者提供最佳治疗方案，但也考虑到医疗、社会和职业因素。
