SYSTEMATIC SURGICAL CLOSURE OF PATENT FORAMEN OVALE IN SELECTED PATIENTS WITH CEREBROVASCULAR EVENTS DUE TO PARADOXICAL EMBOLISM - EARLY RESULTS OF A PRELIMINARY-STUDY

Objective: To define therapeutic strategy for management of patients w ith ischemic stroke due to a high probability of paradoxical embolism through a Patent Foramen Ovale (PFO). Methods: Since 1988 all consecut ive patients with cerebrovascular events and PFO from the Stroke Regis try of our population-based primary-care center are prospectively stud ied and followed; Since 1992, among 118 patients with cryptogenic embo lic brain infarct or transient ischemic attack (TIA) and PFO, 32 conse cutive patients younger than 60 years who presented at least two of th e following criteria were admitted for surgery: history of Valsalva st rain before stroke (11); multiple clinical events (13); multiple infar cts on brain Magnetic Resonnance Imaging (MRI) (15); atrial septal ane urysm (ASA) (16); large right-to-left shunt (> 50 microbubbles) (12). Results: Operative time 135' +/- 33'. CPB time 34' +/- 14'. Aortic cro ssclamping time 16' +/- 6'. Post-operative bleeding 485 +/- 170 mi. No homologous blood transfusion required. No neurological, cardiac or re nal complications. All patients were followed-up corresponding to a cu mulative time of 601 patient-months. This revealed no reccurent vascul ar events nor silent new brain lesions on brain MRI. Systematic simult aneous contrast Trans Esophageal Echocardiography (TEE)-Trans Cranial Doppler showed a small residual interatrial shunt in two patients. Con clusion: Surgical closure of a patent foramen ovale can be accomplishe d with very low morbidity and reduce efficently the risk of stroke rec urrence. It seems to be the option of choice in selected patients with a higher (> 1.5%/ year) risk of stroke recurrence. (C) 1997 Elsevier Science B.V.