Patent foramen ovale closure: past, present and future

Abstract

Patent foramen ovale (PFO) is a common congenital abnormality that has been implicated in a number of disease processes, including cryptogenic stroke and migraine headaches. Medical treatment for these processes is often considered inadequate and mechanical closure of the PFO is an attractive, albeit controversial, alternative. PFO closure has become common practice in many centers, although recent guidelines limit its indication to certain subsets of patients. This review first focuses on the anatomy, physiology and pathophysiology of PFO, and then reviews the currently available and experimental devices for PFO closure, as well as the present clinical data pertaining to them. Finally, we present our perspective of the PFO closure, with regard to its current use and future directions.

Keywords::

• cerebrovascular accident
• closure devices
• migraine
• patent foramen ovale
• transient ischemic attack

Financial disclosure

Horst Sievert received consulting fees, travel expenses and study honoraria from Abbott, Access Closure, AGA, Angiomed, Boston, CardioKinetix, CardioMEMS, Cierra, Coherex, Coaptus, Cordis, CSI, Edwards, EndoTex, ev3, Gore, Guidant, Lumen Biomedical, Kensey Nash, Mind Guard, NDC, Neovasc, NMT, OAS, Occlutech, Ovalis, Pathway, Percardia, Rox Medical, Sadra, Sorin, St. Jude, Terumo, Topspin, Velocimed and Xtent. He also has stock options and/or stocks in the following companies: Cardiokinetics, Access Closure, Velocimed, Cierra, CoAptus and Lumen Biomedical. Michael C. Slack is a consultant for Aga Medical.