What are the indications for PFO closure in 2023? - EuroPCR 2023

[@flua1508]

Thank you so so much for answering many questions that were in my head!! I have my surgery in about a week and feel better after listening to you!

[@WayneLeng]

I'm a 74 year old and 6 months ago I had two strokes along with a pulmonary embolism and many tiny blood clots. Also had a cardiac arrest while I was in the hospital. There is evidence of older strokes from about 40 years ago. I also have a PFO which was discovered about 40-45 years ago and was told nothing had to be done. I also have migraines with aura. I am currently on Apixaban, a blood thinner.

[@pennyplyman5022]

I am a 64 year old female with a Large PFO. It has caused me to have low blood oxygen, and I have not been able to work for the last two years. I am a foaling attendant in Kentucky to Thoroughbred Race Horses, my job is a 12 hour night shift walking throughout the night, picking stalls, watering horses, delivering 100+ pound horse babies. I need the my PFO closed to gain quality of life and to get back to work. It isn’t right to deny such a relatively simple procedure to those of us needing it. Please keep pursuing this for the greater good of all humans. Thank you for this video!

[@fliphustling]

Do you live in the USA?

[@josephpuchel6497]

My cardiologist sent me to a heart specialist 10 years after my stroke in 2009. He said he wouldn’t do closure because my protein C was slightly lower than normal and still need to be on blood thinner. Protein c has something to do with clotting factor.

[@bonran]

This discussion is full of what is called specialty bias. These are 2 structural interventional cardiologists, wanting to do procedures for reimbursements. Specially the casualness of blowing off atrial fibrillation as a cause of cardioembolic stroke.......it is bordering on malpractice. More and more data has shown that atrial fibrillation (specially paroxysmal atrial fibrillation) is the cause of 20% of all stroke and a large number of cryptogenic strokes when monitored with implantable loop recorders (16-24%) will catch PAF. Besides no one discusses that 10% or more of PFO closures when monitored for 1 year were found to be in atrial fibrillation.......requiring anticoagulation for secondary stroke prevention........thus defeating PFO closure in the first place. Just yesterday I saw a patient in my practice with an embolic stroke who "had previously had a PFO closure". He was on aspirin and clopidogrel. His TEE showed a thrombus sitting in the left atrium on top of the closure device. With the WATCHMAN device, we already know that 24% of them can have a thrombus sitting on the device within 1 year of getting off anticoagulation. Listening to such a biased discussion with 2 interventionalists who appear to be poorly familiar with evidence, have financial incentives to do more procedures is near criminal. Where are the academic stroke neurologists here who have participated in some (not all) of these industry sponsored trials?

[@shkach]

I am a 56 yo female experiencing low oxygen saturation. Was diagnosed with a myopathy that runs in my family (Spereoid Body Myopathy) 10 years ago and have been attributing my weakness and exhaustion to that. It may have been a PFO all along. Trying to get scheduled for an ECHO bubble test to confirm. Please push for this closure procedure for ALL who could benefit from it.

[@glam_goth6662]

Im 55 female, and had stroke 2 weeks ago and they found a PFO.

[@shkach]

So scary! Prayers you have a full recovery! I think they should begin testing babies and closing them then, not waiting for them to become an issue.

[@jeremym1706]

Had the same! Found a 10mm hole (asd) had 2 strokes in 6 months. Luckily id say im all there

[@IceSk8Princessa12]

They cant find Afib on me with 5 days of hospital monitoring plus on mobile ecg for 2 weeks ( this factor was the last criteria to be ruled out) and during my follow up appointment, sent me off to monitor myself with an Apple watch for the next 5 months! This is ridiculous!

[@bonran]

5 days is too short. You need an implantable loop recorder and monitoring for 6 months............go check out the ENHANCE and the CRYSTAL-AF trial. Better to be safe than to get a foreign body in your heart that you might not need, which can form clots on itself, and then find that you had paroxysmal atrial fibrillation; ending up on a strong blood thinner for life which would have treated the PFO medically.