Percutaneous Occlusion of a Patent Foramen Ovale

Abstract

The foramen ovale (FO) is the structure responsible for maintaining the fetal circulation while the lung is still not functioning. The blood passes from the mother to the fetus through the umbilical cord, ascends to the right atrium, and, through the FO, reaches the left atrium, thus nourishing the left side of the heart. Shortly after birth, FO closes; however, approximately 25% of adults have the patent foramen ovale (PFO). The main clinical implications are stroke, migraine, platypnea-orthodeoxia, obstructive sleep apnea, surgical risk for large surgeries, and persistent cyanosis. The method of choice for diagnosis is transesophageal echocardiography (TEE) sensitized by injection of saline solution with microbubbles at the end of the sustained Valsalva maneuver. The available therapeutic approaches consist of the drug treatment (antiplatelet and anticoagulant drugs) in the surgical or percutaneous closure. We report a case of female patient, 39 years old, with a complaint of migraine with aura, debilitating and refractory to medications since her childhood, and dyspnea on average efforts for 5 years, with no other concomitant symptoms. At 27, she suffered a stroke with no thrombogenic focus found, which left no sequelae. During a cardiological investigation, a TEE was performed and PFO was visualized. From this, endovascular treatment with occlusion device was chosen because it is highly recommended for percutaneous closure of PFO with a history of stroke without an identifiable cause and evidence of right-to-left shunt identified by TEE in patients less than 55 years. In the sixth month after the procedure, a new TEE was performed, which revealed preserved left ventricular global systolic function and normal relaxation, without detectable residual shunt, in addition to the patient reporting complete remission of migraine.