JAMA Clinical Reviews Patent Foramen Ovale-Associated Stroke
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Jul 28, 2025 David M. Kent, a Professor of Medicine and Neurology at Tufts University, dives into the intriguing world of patent foramen ovale (PFO) and its link to cryptogenic strokes. He discusses how to determine if a PFO is the culprit behind a stroke and the potential benefits of closure to prevent recurrences. The conversation also highlights the anatomical challenges of detecting PFOs and the advanced imaging techniques essential for accurate diagnosis. Kent emphasizes the collaborative role of neurologists and cardiologists in managing stroke risk factors related to PFO.
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Key Stroke Evaluation Steps
- Stroke causes cluster into four main categories: infarct visualization, large vessel imaging, cardiac rhythm, and cardiac structure.
- Identifying stroke cause is critical as treatment varies by cause.
Monitor Long for Atrial Fibrillation
- Prolonged cardiac monitoring is recommended for atrial fibrillation detection after stroke, duration varies by guideline.
- Balance longer monitoring benefit with causality certainty when attributing stroke to PFO or atrial fibrillation.
Foramen Ovale Function and Prevalence
- Foramen ovale enables fetal blood to bypass nonfunctioning lungs before birth.
- After birth, increased left atrial pressure seals the foramen ovale, but in 25% it remains patent.