Patent foramen ovale closure and brain ischaemic lesions

To the Editor The recently published meta-analysis by Wolfrum et al assessed the ability of percutaneous closure of patent foramen ovale (PFO) to reduce the incidence of recurrent stroke based on three randomised controlled clinical trials (RCT). This analysis did not demonstrate a superiority of the closure of PFO compared with medical therapy after 2–4 years of follow-up in patients with cryptogenic embolism.1 The closure was associated with lower, albeit nonsignificant, incidence of nonfatal stroke. The relatively low incidence of nonfatal strokes in the medical arm (<1% per year), could have contributed to make it difficult to demonstrate a clear-cut clinical benefit of the closure. On the other hand, it is reasonable to assume that far more subclinical brain damage occurs in patients with PFO.2 We believe that the ischaemic cerebral burden (predominantly clinically silent) demonstrable by MRI of the brain could be used as a...

Source: Heart - September 20, 2013 Category: Cardiology Authors: Ammirati, E., Comi, G., Camici, P. G. Tags: PostScript Source Type: research