SURGICAL CLOSURE OF PATENT FORAMEN OVALE IN CRYPTOGENIC STROKE PATIENTS

Background and Purpose Patent foramen ovale (PFO) is associated with s troke of unknown etiology or cryptogenic stroke. However, optimal trea tment to prevent recurrence in cryptogenic stroke patients with PFO is not clearly defined. Since PFO represents a surgically repairable les ion, interest in closing it is high. This report reviews our experienc e with cryptogenic stroke patients with PFO who underwent surgical PFO closure and were followed for recurrence of neurological events. Meth ods We followed 28 cryptogenic stroke patients (17 men. 11 women; mean age, 41 +/- 13 years) with transesophageal echocardiograpy-defined PF O who had undergone PFO closure by open thoracatomy. All patients sele cted for surgery refused, could not take, or failed warfarin therapy. They were followed by physician visits and telephone interviews. Resul ts There were no surgical complications. With a mean follow-up of 19 m onths, four patients experienced neurological event recurrence, one st roke, and three transient ischemic attacks. Kaplan-Meier survival anal ysis demonstrated that the actuarial rate of recurrence was 19.5% (95% confidence limit 2.2 - 36.8%) at 13 months of follow-up. None of the 17 patients (0%) younger than 45 years suffered a recurrence, whereas four of 11 patients (35%) aged 45 or older experienced a recurrence of neurological event (P < .02). Using a proportional hazards regression model. the increase in relative risk with increasing age was 2.76 per 10 years (95% confidence interval 1.07 to 7.16). Conclusions Although PFO is easily repairable in patients with cryptogenic stroke, its clo sure does not consistently prevent recurrence of ischemic events. The recurrence appears to occur more frequently in older cryptogenic strok e patients.