A Case Series Coexistence of PFO with Other Conditions - Who’s the Culprit?
- Background: Patent foramen ovale (PFO) is a major cause of cryptogenic stroke (CS). However, it is still possible that PFO comes with those other conditions during evaluation. This paper presents a series of CS cases highly suspected due to PFO origin with each of its special presentations.
- Case illustration/summary of a review article: We present three cases of CS with PFO as a possible contributing factor. Case 1 showed a patient with repeated ischemic strokes that was investigated to be cryptogenic in origin. Case 2 showed CS with PFO and occult atrial fibrillation. Case 3 showed CS at a young age caused by a PFO with protein C/S deficiency.
- Conclusion: The role of PFO as a culprit, risk factor, or a coincidental finding in CS is still debatable and is a controversial issue. Determining PFO as a cause of CS requires a thorough consideration of clinical and PFO anatomical/morphological factors.
2. Bednarski J. The role of cardiac diagnostics in cryptogenic stroke: the current state of knowledge. Folia Cardiol. 2019;14:356-362.
3. AHA/ASA. Understanding Diagnosis and Treatment of Cryptogenic Stroke. 2015:24.
4. Ioannidis SG, Mitsias PD. Patent foramen ovale in cryptogenic ischemic stroke: Direct cause, risk factor, or incidental finding? Front Neurol. 2020;11:5-7.
5. Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Stroke Compendium. 2017:527-541.
6. Kent DM, Ruthazer R, Weimar C, Angelantonio D, Tullio MR Di, Lutz JS, Elkind MS V, Griffith J, Jaigobin C, Papetti F. RoPE Score (Neurology 2013). 2013.
7. Hołda MK, Koziej M. Morphometric Features of Patent Foramen Ovale as a Risk Factor of Cerebrovascular Accidents: A Systematic Review and Meta-Analysis. Cerebrovasc Dis. 2020;49:1-9.
8. Sanna T, Ziegler PD, Crea F. Detection and management of atrial fibrillation after cryptogenic stroke or embolic stroke of undetermined source. Clin Cardiol. 2018;41:426-432.
9. Zhang C, Kasner S. Diagnosis, prognosis, and management of cryptogenic stroke. F1000Research. 2016;5:1-6.
10. Kent DM, Saver JL, Ruthazer R, Furlan AJ, Reisman M, Carroll JD, Smalling RW, Jüni P, Mattle HP, Meier B, Thaler DE. Risk of Paradoxical Embolism (RoPE)-Estimated Attributable Fraction Correlates with the Benefit of Patent Foramen Ovale Closure: An Analysis of 3 Trials. Stroke. 2020:3119-3123.
11. Daher G, Hassanieh I, Malhotra N, Mohammed K, Switzer MP, Mehdirad A. Patent foramen ovale prevalence in atrial fibrillation patients and its clinical significance; A single center experience. Int J Cardiol. 2020;300:165-167.
12. Kjeld T, Jørgensen TS, Fornitz G, Roland J, Arendrup HC. Patent foramen ovale and atrial fibrillation as causes of cryptogenic stroke: is treatment with surgery superior to device closure and anticoagulation? A review of the literature. Acta Radiol Open. 2018;7:205846011879392.
13. Melduni RM, Wysokinski WE, Wang Z, Gersh BJ, Asirvatham SJ, Patlolla SH, Greene EL, Oh JK, Lee HC. Prognostic significance of patent foramen ovale in anticoagulated patients with atrial fibrillation. Open Hear. 2020;7:1-8.
14. Ng KWP, Loh PK, Sharma VK. Role of investigating thrombophilic disorders in young stroke. Stroke Res Treat. 2011;2011.
15. Chiasakul T, De Jesus E, Tong J, Chen Y, Crowther M, Garcia D, Chai-Adisaksopha C, Messé SR, Cuker A. Inherited Thrombophilia and the Risk of Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019;8.
16. Hviid CVB, Simonsen CZ, Hvas AM. Recurrence Risk in Patients with Cryptogenic Stroke, Patent Foramen Ovale, and Thrombophilia: A Systematic Review and Meta-Analysis. Thromb Haemost. 2019;119:1839-1848.
PDF downloads: 429
Copyright (c) 2021 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).