Stroke causing paralysis is one of most dreaded disease . It has both short and long term implications in terms of survival and quality of life. It is also a huge burden on the family due to the long term care needed by the patient and the finances involved .
One of the least diagnosed and easily missed cause of stroke is a PFO (patent foramen ovale). PFO is a small hole normally present in all unborn babies. It is small opening in the wall separating the left and right collecting chambers of the heart. This typically closes after birth.
But In 25% of general population it persists even afterbirth and it does not cause any harm in most of the persons. In a very few percentage of such persons, PFO may be responsible for a stroke. It can happen in all age groups, though we suspect it specially in young stroke patients.
In a stroke patient we need to evaluate for the common causes of stroke. In the absence of any common causes of stroke, we term it as a case of ‘Cryptogenic stroke’. If PFO is present in a case of cryptogenic stroke, then we need to close it to prevent recurrent attacks of stroke.
The benefit of PFO device closure in Cryptogenic stroke has long been debated. Only recently two large multinational randomized patient trials named RESPECT and REDUCE trials, proved the benefit after which it got acceptance in the medical community. So it’s a relatively new procedure and hence not commonly done.
PFO closure is only indicated after diagnosing cryptogenic stroke to prevent recurrence of stroke. It is never indicated in normal individuals with PFO.
PFO closure is done using minimally invasive technique where we introduce the device through a small incision in the leg. It takes about 30 minutes to close it and patient will be mobile after 3 hours and can be discharged the very next day. He will be on low dose blood thinners for a few months.He need to come for a repeat echo after a week in OPD.