Page 76 - BH-3-3

Brain & Heart

MINI-REVIEW
Guidance for the treatment of patent foramen

ovale: Classic indications, recent updates, and
new consensus perspectives

2
1
Christian Pristipino * , Tommaso Guidotti Fanuele , Nathan Elbeze ,
1
and Laurent Sebagh 1
1 Institut Cœur Paris Centre, Clinique Turin, Paris, France
2 Service de Cardiologie Médicale, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
(This article belongs to the Special Issue: Correlation between Ischemic Heart Disease and
Cerebrovascular Disease: The Clinical Practice Messages from the Aosta Meeting in June 2024)

Abstract

The paradigm of patent foramen ovale (PFO)-associated syndrome management has
been significantly influenced by seminal guidance documents, which underscore
the importance of multidisciplinary collaboration and individualized decision-
making frameworks. Since the first European Position Papers published in 2018 and
2021, these documents have provided a structured template for the evaluation and
treatment of cryptogenic stroke, desaturation syndromes, decompression sickness
(DCS), and migraine with aura, thereby facilitating a more nuanced approach
to patient care. A critical examination of the current indications for PFO closure
reveals a notable lack of evolution over the past 5 years, with recommendations
*Corresponding author: largely mirroring those previously established. Specifically, PFO closure is presently
Christian Pristipino
(pristipino@icpc.fr) advocated for patients aged 18–60 years with cryptogenic stroke and high-risk
features, as well as for select individuals over 60 years following exhaustive exclusion
Citation: Pristipino C, Fanuele TG, of alternative etiologies. Conversely, PFO closure remains the standard of care for
Elbeze N, Sebagh L. Guidance for
the treatment of patent foramen severe desaturation syndromes, is selectively employed for PFO-related DCS, and is
ovale: Classic indications, recent considered investigational for migraine with aura. The inherent heterogeneity of PFO-
updates, and new consensus associated syndromes poses a significant challenge to the development of precision-
perspectives. Brain & Heart.
2025;3(3):8133. based treatment strategies, highlighting the need for innovative, multidimensional
doi: 10.36922/bh.8133 approaches that integrate advanced technologies and personalized algorithms to
Received: December 23, 2024 elucidate distinct phenotypic profiles and optimize therapeutic outcomes. Ultimately,
the stagnation of current treatment paradigms underscores the imperative for
Accepted: February 27, 2025
continued research and clinical innovation, with a focus on refining patient selection
Published online: June 20, 2025 criteria and enhancing the efficacy and safety of interventions such as PFO closure.
Copyright: © 2025 Author(s).
This is an Open-Access article
distributed under the terms of the Keywords: Patent foramen ovale; Cryptogenic stroke; Decompression sickness;
Creative Commons Attribution Desaturation syndromes; Migraine; Percutaneous closure
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited.
1. Introduction
Publisher’s Note: AccScience
Publishing remains neutral with Patent foramen ovale (PFO) has become a keystone in the management of specific patient
regard to jurisdictional claims in
published maps and institutional populations, most notably those with cryptogenic stroke and systemic embolism. Beyond
affiliations. these well-established indications, a growing body of evidence has linked PFO to other

Volume 3 Issue 3 (2025) 1 doi: 10.36922/bh.8133