{"id":67358,"date":"2026-06-13T15:09:02","date_gmt":"2026-06-13T09:39:02","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=67358"},"modified":"2026-06-13T15:09:04","modified_gmt":"2026-06-13T09:39:04","slug":"current-status-of-pfo-closure-whether-it-is-needed","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/current-status-of-pfo-closure-whether-it-is-needed\/","title":{"rendered":"Current Status of PFO Closure &#8211; Whether it is needed?"},"content":{"rendered":"<iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/b1BrFrcGjyw?si=8eTYU3lkMZNtDQyT\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n\n<p class=\"wp-block-paragraph\">For most people, a patent foramen ovale (PFO) never needs to be closed. It is a common anatomical variant present in about 25% of the general population and is usually an incidental finding. However, over the last few years, some major clinical trials have shown that PFO closure is beneficial for a very specific subset of patients to prevent recurrent strokes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Here is a breakdown of the current medical consensus on when PFO closure is needed and when it isn&#8217;t.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">When PFO Closure is Strongly Indicated<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The primary, evidence-based reason to close a PFO is for the <strong>secondary prevention of cryptogenic stroke<\/strong> (a stroke with no identifiable cause, also known as Embolic Stroke of Undetermined Source or ESUS).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Based on landmark trials like <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1610057\" type=\"link\" id=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1610057\">RESPECT<\/a>, <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1705915\" type=\"link\" id=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1705915\">CLOSE<\/a>, <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1707404\" type=\"link\" id=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1707404\">REDUCE<\/a>, and <a href=\"https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2018.02.046\" type=\"link\" id=\"https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2018.02.046\">DEFENSE-PFO<\/a>, closure is generally recommended if the patient meets these criteria:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Age:<\/strong> Typically under 60 years old.<\/li>\n\n\n\n<li class=\"\"><strong>Event:<\/strong> Has suffered an ischemic stroke or transient ischemic attack (TIA) that is deemed cryptogenic after a thorough neurological and cardiac workup (e.g., ruling out carotid disease and atrial fibrillation).<\/li>\n\n\n\n<li class=\"\"><strong>Anatomy:<\/strong> The PFO has &#8220;high-risk&#8221; anatomical features, such as a large right-to-left shunt or an associated Atrial Septal Aneurysm (ASA).<\/li>\n\n\n\n<li class=\"\"><strong>RoPE Score:<\/strong> A high <a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.120.032453\" type=\"link\" id=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.120.032453\">Risk of Paradoxical Embolism (RoPE) score<\/a> (usually \u22657), which suggests the stroke was highly likely caused by a blood clot passing through the PFO rather than standard vascular disease. The RoPE score is a 10-point index designed to help distinguish whether a PFO in the setting of a cryptogenic stroke is pathogenic (the actual cause) or merely an incidental finding.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In these patients, combining a percutaneous device closure with antiplatelet therapy reduces the risk of recurrent stroke significantly more than medical therapy alone.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Rare but Acceptable Indications<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Aside from stroke, there are a few specific scenarios where closure is considered:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.024609\" type=\"link\" id=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.024609\">Platypnea-Orthodeoxia Syndrome<\/a>:<\/strong> A rare condition where a patient experiences shortness of breath and a drop in blood oxygen levels when sitting or standing up, but not when lying down. PFO closure is often highly effective for this.<\/li>\n\n\n\n<li class=\"\"><strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34810112\/\" type=\"link\" id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34810112\/\">Decompression Illness<\/a>:<\/strong> Professional or frequent scuba divers who experience decompression sickness due to a PFO may undergo closure if they wish to continue deep diving without restrictions.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">When PFO Closure is NOT Recommended<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"\"><strong>Primary Prevention:<\/strong> Finding a PFO incidentally on an echocardiogram in someone who has never had a stroke or related symptoms does not warrant closure, regardless of the size of the PFO.<\/li>\n\n\n\n<li class=\"\"><strong>Migraines:<\/strong> While observational data showed that some patients experienced relief from migraines with aura after a PFO closure, randomized controlled trials (like <a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/circulationaha.107.727271\" type=\"link\" id=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/circulationaha.107.727271\">MIST<\/a>, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26908949\/\" type=\"link\" id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26908949\/\">PRIMA<\/a>, and <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29191325\/\" type=\"link\" id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29191325\/\">PREMIUM<\/a>) failed to prove that routine closure cures migraines. It is currently not recommended as a primary treatment for migraines.<\/li>\n\n\n\n<li class=\"\"><strong>Older Patients (>60 years):<\/strong> Routine closure in older patients with a cryptogenic stroke is still debated. In this age group, occult atrial fibrillation is a much more likely cause of stroke than a PFO, so prolonged cardiac monitoring (like an implantable loop recorder) is usually required before a PFO is blamed.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Atrial Fibrillation &#8211; A Notable Risk!<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">PFO closure is generally a safe, minimally invasive transcatheter procedure (done through a vein in the groin) that takes less than an hour. <strong>Apart from the usual invasive procedure related risks<\/strong>, the most notable risk associated with the procedure is a <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1705915\" type=\"link\" id=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1705915\">higher incidence of new-onset <strong>Atrial Fibrillation<\/strong><\/a><strong> (AFib)<\/strong> following the device implantation seen in some studies. Trials showed an AFib rate of roughly 4% to <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1707404\" type=\"link\" id=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1707404\">6% post-procedure<\/a>, which is why careful patient selection and post-procedure rhythm monitoring are crucial.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>For most people, a patent foramen ovale (PFO) never needs to be closed. It is a common anatomical variant present in about 25% of the general population and is usually an incidental finding. However, over the last few years, some major clinical trials have shown that PFO closure is beneficial for a very specific subset [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":67359,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-67358","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Current Status of PFO Closure - Whether it is needed? - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/current-status-of-pfo-closure-whether-it-is-needed\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Current Status of PFO Closure - Whether it is needed? - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"For most people, a patent foramen ovale (PFO) never needs to be closed. It is a common anatomical variant present in about 25% of the general population and is usually an incidental finding. 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