There continues to be a disagreement between the neurological and vascular communities as to when to close the PFO (Patent Foramen Ovale) - the hole in the heart between the right and left atria): the former state that it should be done only after the occurrence of the second stroke, with anticoagulation medicines administered after the first stroke, and this is currently the prevailing practice.

The vascular community contends, however, that since approximately 1/3 of strokes are debilitating, the PFO closure should be undertaken much earlier.

Ted Feldman, M.D., Professor of Medicine at the Northwestern University Medical School and Director, Cardiac Catheterization Laboratory at Evanston Hospital in Evanston, Illinois, debated the benefits of the latter opinion at the VEITHsymposium.

The patients having strokes due to PFO are relatively young - median age of 45. It has also been noted that the majority of those who collapse and die after an airline trip have a high prevalence of PFO, further evidence that the PFO closure should be done earlier than is presently being done.

A number of investigators have noted a link between migraine headache and PFO. The frequency of PFO in the migraine population ranges from 40% to 60%, compared with 15% to 25% in the general population. It has also been observed that migraine headaches associated with a shunt from a PFO responds favorably to atrial septal repair in patients treated with PFO closure for stroke.

Many retrospective studies have confirmed this finding and this has led to a prospective, randomized trial of PFO closure versus sham procedure in a non stroke migraine population.

VEITH SYMPOSIUM - New York, November 19th to 23rd

Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.

VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.


Pauline T. Mayer

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