In Reply: We agree with the main assertions made by Drs Bhindi and Ormerod. The data available did not allow for distinction between PFO and ASD, and any comment on indications for the procedure must be qualified. The relative increase in the rate of coronary revascularization procedures was included to provide general perspective; direct comparison between these procedures is limited.
In terms of PFO closure, we agree that management decisions for PFO must be individualized and that certain characteristics of PFO may help predict the risk of a neurological event. Some observational data suggest that certain atrial septal characteristics predict higher stroke risk, although there are conflicting reports.1,2 Given the potential for selection and ascertainment bias in these studies (eg, echocardiographers may “look harder” to make a diagnosis of PFO in patients with cryptogenic stroke), data must be interpreted with caution.2
Opotowsky AR, Landzberg MJ, Webb GD. Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defect—Reply. JAMA. 2008;299(19):2272-2273. doi:10.1001/jama.299.19.2272-b