‘PFO’ should be investigated in strokes of unknown cause’

Cardiology Specialist Assoc. Dr. Selcuk Kucukseymen, He explained what should be known about patent foramen ovale (PFO) and its treatment. Küçükseymen stated that during the development of the baby while in the mother’s womb, there is a foramen ovale opening, which is a valve-like structure between the right and left atrium of the heart.During infancy, this valve closes on its own, but if it does not, a condition called patent foramen ovale (PFO) occurs. About 20 percent of healthy adult people have PFO, and young adults (under 60) with PFOs have a 40-50 percent higher risk of stroke compared to those without PFOs. In addition, the frequency of PFO in these patients was reported to be higher than in healthy individuals.” said.

Küçükseymen emphasized that if the cause of stroke under the age of 60 cannot be found (cryptogenic) serious research should be done in terms of PFO, “In addition, the incidence of clot formation in the veins of the legs (deep vein thrombosis-DVT) is higher in patients who have had a stroke of unknown origin. The association between PFO and stroke of unknown origin is more evident in young adults than in the elderly. A person with a PFO who has had a stroke of unknown cause has a reported 2.5 percent risk of having another stroke for each next year.” he said.

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Küçükseymen drew attention to the fact that divers with PFO have a 5 times higher risk of being hit than those who do not, and continued his speech as follows:Apart from these, although the relationship between PFO and migraine is still not fully resolved, there are data suggesting that PFO has a role in migraine cases with aura. It is known that the frequency of PFO increases up to two times in patients with migraine with aura compared to healthy individuals, and closure of PFO reduces migraine headaches. Most people do not have symptoms of patent foramen ovale. In rare cases, PFO migraine can occur, as can shortness of breath when standing up and standing. PFO presents as a higher risk for certain types of stroke.


Young-adult (under 60 years old) stroke patients undergo an intensive investigation by a neurologist to determine the cause of stroke.Küçükseymen said: “Neurology and cardiology specialist physicians evaluate cases for which the cause cannot be found. Since normal echocardiographic examination does not provide very clear imaging in adult patients, echocardiographic examination of the esophagus (transesophageal echocardiography) should be performed in these patients. During this procedure, the passage can be monitored by administering serum from the arm veins.

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Küçükseymen reported that transcranial Doppler scanning, performed by neurology, is a method that indirectly shows the presence of PFO and is performed by measuring the ultrasonic signals generated in the cerebral artery by the serum given from the vein in the arm. Küçükseymen said that although it is a more comfortable method, the diagnosis should be confirmed with echocardiography when the test is positive. The PFO closure procedure is decided after the risk of overdose and the foreseeable risks of the procedure are shared with the patient.


Stating that the PFO can be closed without surgery, Küçükseymen said, “In the procedure, a needle is inserted through the inguinal vein (femoral vein) and a wire is sent from there to the heart and passes through the PFO. The closing device, which is selected in the appropriate size for the PFO, is advanced through the groin and passed through the hole. The device closes the hole by sitting on it from both sides. Before the device is released, it is checked that the PFO is closed properly and that the inserted device does not harm other parts of the heart, and the process is terminated. Within 3-6 months after the procedure, the cell layer (endocardium) covering the inside of the heart covers the closure device and the device now becomes a part of the body.

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Things to consider after the procedure

Finally, Küçükseymen explains what needs to be done after the procedure, “PFO closure takes about 1 hour on average. Depending on the devices used, the patient may be awake or slightly asleep during the procedure. After the procedure, the patient stays in bed for at least 6 hours and stays in the hospital for one night and is discharged in the morning. It is recommended to use blood thinners for a short time to prevent clot formation on the closure device. After resting at home for a few days, the patient can return to his daily activities. Situations that cause them to be hit and contact sports (such as karate, boxing, wrestling, weightlifting) should be avoided for 6 weeks.

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