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When should we close a patent foramen ovale?. Volume 3, issue 1, Janvier-Février 2007

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Authors
Département de cardiologie, hôpital Bichat, 46 rue Henri-Huchard, 75018 Paris, Département d’anesthésie-réanimation, Centre de diagnostic et de traitement de l’attaque cérébrale

With the current development in echocardiographic technologies patent foramen ovale can be identified in nearly 25 % of the general population. When a PFO is suspected, transthoracic echocardiography with a contrast test using a Valsalva manoeuvre is the first step of examination. Transesophageal echocardiography is mandatory in order to detect other abnormalities, especially an atrial septal aneurysm (ASA). Most often, PFO (w/o ASA) is diagnosed in a young patient after a first cryptogenic stroke. Indication of PFO closure must be discussed after a thorough examination and with a close collaboration with the neurologic staff. Randomized trials are warranted before the completion of guidelines. Although migraine episodes can decrease after PFO closure, further investigations are needed before a global screening for PFO in migrainers. Randomized trials are still ongoing in this setting. The risk of decompression illness in divers with PFO can lead either to a PFO closure or to a cessation or modification in diving habits. PFO closure in some forms of severe hypoxemia without pulmonary hypertension may have some spectacular effects.