Patent foramen ovale closure in a young mother after a stroke

A 39-year-old mother of 2 teenage boys, who was also a nurse, became permanently aphasic because of a stroke. Diligent workup found no cause, other than a patent foramen ovale (PFO) associated with an atrial septal aneurysm (Figure 1). The PFO was closed using a 25-mm Amplatzer® PFO Occluder (Figure 2) during an outpatient procedure. The patient was treated with clopidogrel (Plavix) for 1 month and aspirin for 5 months; no physical restrictions were prescribed. Endocarditis prophylaxis was recommended for the first 3 months. The 6-month follow-up transesophageal echocardiogram showed complete closure (Figure 3).

This particular case is anecdotal but nonetheless compelling. The patient had suffered from severe migraine headaches with aura for 10 years. If an evaluation for PFO had been performed earlier because of her migraines and the PFO closed before the stroke, the patient would have avoided the fate of coping with a lifelong disability, which was especially challenging because of her responsibility to raise 2 sons.