Patent foramen ovale and the brain–heart team : From a cardiologist's perspective

Abstract

Since the first approval of transcatheter patent foramen ovale (PFO) closure device in Japan in 2019, this procedure has become an essential strategy for preventing recurrent cryptogenic strokes related to PFO. Clinical evidence, particularly from the long–term follow–up of the RESPECT trial, has demonstrated the superiority of PFO closure over medical therapy.

We established the “simple PFO implantation method” at the Saiseikai Kumamoto Hospital Cardiovascular Center to minimize patient burden while ensuring high procedural reliability. This approach utilizes local anesthesia and intracardiac echocardiography guidance rather than general anesthesia and transesophageal echocardiography. By implementing a two–day clinical path, optimizing sheath sizes, and skipping balloon sizing in standard cases, we reduced procedural times to less than 30 minutes.

By the end of 2025, our center had performed 47 PFO closures, with a procedural success rate of 95.7%. No major complications were noted. National post–marketing surveillance data in Japan further support these findings, showing a 99.8% procedural success rate and a 91.5% effective closure rate at one year. While guidelines primarily recommend the procedure for patients under 60 years of age, real–world data indicate that approximately 30% of treated patients are older, highlighting the importance of individualized clinical judgment.

Although PFO closure has evolved into a safe and simplified procedure, its clinical success depends heavily on the accurate diagnosis of PFO–related stroke. Integrating the expertise of neurologists and cardiologists through a “brain-heart team” is essential for optimal patient selection and long–term prevention of neurological events.