In recent years, the correlation between a small congenital hole in the heart and the occurrence of an ischemic stroke at a young age has become increasingly important and known. This hole is located between the two upper chambers of the heart called the atria and is called the foramen ovale or PFO.

This intracardiac communication is present in fetal life for fetal circulation to occur, and it closes automatically in the first years of life in 75-80%. Therefore, adults have in a large percentage up to 25% a residual small communication through the foramen ovale, which, however, does not create a problem in most cases and thus we do not investigate them to detect who has it and who does not.

However, in cases where a young person, mainly between the 3rd and 5th decade of life, has an unexplained transient stroke, a cycle of tests to find the generative cause is necessary, including an ultrasound study of the heart through a transesophageal ultrasound.

The presence of a foramen ovale is blamed for the passage of a clot through it when it has specific anatomical characteristics that make it high risk, but especially when there are no other risk factors, such as thrombophilia, malignant arrhythmias, hypertension, diabetes mellitus, etc.

In this way, a risk classification called “rope score” is formed and has a maximum rating of 10 points. The higher the score, the more likely the stroke is related to PFO-type intracardiac communication. Age between 60-69 years counts 1 point, 50-59 years two, 40-49 years three, 30-39 years four and 18-29 years counts five points. Absence of arterial hypertension/diabetes, previous stroke, positive MRI for cerebral infarction and smoking, all count for one point each, adding up together with age to 10 points, which is the maximum.

In order to diagnose a thromboembolic stroke, the brain MRI must be positive. As long as no other causes are found responsible for thrombus embolism to the brain, closure of the intracardiac communication is recommended.

The preferred method of convergence is by cardiac catheterization, in which an implant-device is placed intracardially, which closes the communication. The method is completely safe and has already been used for more than 4 decades. Closure devices, commonly called “umbrella type devices”, are always double disc models applied on either side of the diaphragm. They consist of soft nickel metal with titanium (nitinol), while there is also a platinum-coated device model for patients allergic to nickel.

Hospitalization after placement of the endocardial closure device is one day, and the patient then receives aspirin or other antiplatelet therapy for a total of 6 months, until the device is completely epithelialized (covered) by the body. The agreement to stop the treatment beyond 6 months is always made in agreement with the Neurologist and in relation to the clinical and imaging image from the magnetic brain. It is noted that in children, thromboembolic events through the foramen ovale are extremely rare, even non-existent, with the exception of severe hereditary thrombophilia, etc. and therefore, children with PFO do not require special investigation or management.