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| Patent foramen ovale deemed not to be a risk factor for stroke |
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30 January 2006
A new prospective study, in an unselected population sample, has found that patent foramen ovale (PFO) is not an independent risk factor for cerebrovascular events, according to a report in the January 17 issue of the Journal of the American College of Cardiology.
While only 11 people in the study had atrial septal aneurysms, and two strokes occurred in this group, the association persisted in univariate analysis and after adjustment for risk factors, Dr Meissner and her colleagues write.
The group conclude that a larger study is necessary to better understand the relationship between atrial septal aneurysm and stroke. Closure of a PFO may be appropriate in patients with cryptogenic stroke and the right history and right physical finding. Evaluation by an expert cardiologist and a cardiovascular neurologist is necessary before such a decision can be made, after which a patient can either undergo closure or be enrolled in one of the ongoing randomised studies comparing closure to medical treatment.
There is still strong evidence that PFO increases stroke risk, Dr Bernhard Meier of the Swiss Cardiovascular Center Bern, who has invented a device for closing PFOs, argues in an editorial accompanying the study. "Lacking techniques to check for pulmonary venous thrombi and in light of extremely simple, safe, and reliable percutaneous, catheter-based methods to close a PFO permanently in <15 min with the awake patient being incapacitated for <2 h, we will continue to be tempted to pound on the nail with this elegant hammer," he writes.
Reference:
J Am Coll Cardiol 2006; 47 (2): 440-445.
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