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Patent foramen ovale
  1. Vafa Alakbarzade1,
  2. Tracey Keteepe-Arachi2,
  3. Nazia Karsan2,
  4. Robin Ray2,
  5. Anthony C Pereira2
  1. 1Neurology, Royal Cornwall Hospitals NHS Trust, Truro, UK
  2. 2Saint George’s University Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Vafa Alakbarzade, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LQ, UK; vafa.alakbarzade.10{at}


Patent foramen ovale (PFO) is the most common anatomical cause of an interatrial shunt. It is usually asymptomatic but may cause paradoxical embolism, manifesting as stroke, myocardial infarction or visceral/peripheral ischaemia. PFO is a risk factor for stroke and may be associated with migraine with aura. New evidence suggests PFO closure reduces the risk of recurrent ischaemic stroke in a highly selected population of stroke survivors: those aged 60 years or younger with a cryptogenic stroke syndrome, a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation. They benefit from percutaneous PFO closure in addition to antiplatelet therapy, rather than antiplatelet therapy alone. Current evidence does not support PFO closure in the treatment of migraine.

  • stroke
  • migraine
  • interventional
  • cardiology
  • cerebrovascular disease

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  • Contributors VA, TK-A and NK wrote the manuscript. RR and ACP reviewed, edited and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed by Tom Hughes, Cardiff, UK, and William Whiteley, Edinburgh, UK.