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August 3, 2020

Perioperative Stroke Risk Reduction in Patients With Patent Foramen Ovale

Author Affiliations
  • 1Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
  • 2Division of Cardiology, Department of Medicine, New York University School of Medicine, New York
  • 3Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
JAMA Neurol. 2020;77(12):1479-1480. doi:10.1001/jamaneurol.2020.2619

The foramen ovale is a fetal connection between the right and left atria that typically closes within a few months of birth but remains patent in 25% to 30% of individuals.1 A patent foramen ovale (PFO) is usually benign, but in some individuals, a PFO-related embolic stroke may occur. Proposed mechanisms of PFO-related embolism include in situ thrombosis and paradoxical embolism, ie, when venous thromboembolism (VTE) passes into the systemic arterial circulation through the PFO.

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1 Comment for this article
Patent Foramen Ovale in Poor Patients
Khichar Shubhakaran, MD(Med), D.M. (Neurology) | MDM Hospital, Dr. S.Nn. Medical College, Jodhpur, India-342003
A nice article of course. Diagnostic work-up of PFO as a cause of stroke requires rigorous work-up and follow-up which is not possible without an adequate optimal standard of health care unavailable to many patients in lower-resource countries. Poverty is a problematic aspect of stroke prevention. Further insights into causal factors and other factors of predictability for stroke are needed, as is awareness of PFO as an underlying cause to build support for its work-up where people need to marshal resources to pay for it..