A LASTING
FIX

PFO Device Closure – Permanent cure
for Cryptogenic Stroke

Cryptogenic Stroke (CS) is defined as Cerebral Ischemia( BRAIN ATTACK) of unknown origin. The cause of Cryptogenic Stroke remains undetermined because the event is transitory or reversible or investigations could not ascertain all possible causes, or because some causes truly remain unknown. One third of the Ischemic Strokes are Cryptogenic, wherein we cannot find any cause. Upto 40% of Cryptogenic Strokes are found to have concurrent PFO (Patent Foramen Ovale) which is a hole in the heart. Patients with Cryptogenic Stroke and PFO are at low risk of having recurrent cerebrovascular events. As per the current advice from guidelines, it is suggested that transcatheter closure of PFO should only be considered for patients with recurrent Cryptogenic Stroke on optimal medical management.

A 49-year-old female patient was admitted to BLK with complaints of right sided weakness and was diagnosed having non-hemorrhagic infarct involving grey and adjoining subcortical white matter of left medial frontal lobe. There were multiple areas of Cystic Encephalomalacia with surrounding gliosis involving middle and inferior frontal gyri and left parieto-occipital

lobe medially mild ex-vacuo dilatation of left ventricle. Also few punctuate foci in the right frontal subcortical white matter s/o chronic ischemic changes. She was having past H/O CVA in a similar episode in 2008.


1
This is the first case of PFO device closure for the treatment of cryptogenic stroke performed at BLK Super Speciality Hospital.
1

On evaluation of etiology of the recurrent CVA, she was found having PFO on TEE (right to left flow on valsalva). Thus, a decision was made to go ahead with PFO intervention. PFO device (25mm) closure was done through the right femoral vein under local anaesthesia using 12 F sheeth resulting in no flow across the device. Subsequently, successful closure of PFO was achieved. The patient was advised to be on dual antiplatelets for one month followed by single antiplatelet.

1
Dr. Subhash Chandra

Dr. Subhash Chandra
Chairman & HOD
Cardiology
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi

Dr. Satbir Singh

Dr. Satbir Singh
Sr. Consultant
Cardiology
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi

Dr. Dheeraj Gandotra

Dr. Dheeraj Gandotra
Consultant
Cardiology
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi