Cryptogenic stroke, patent foramen ovale, and ASD closure

Excluding bicuspid aortic valve, atrial septal defect (ASD) is the most common congenital defect first recognized in adulthood while a patent foramen ovale (PFO) is found in 20-30% of normal adults. PFOs can be closed as secondary prevention after a stroke or transient ischemic attack (TIA) although the effectiveness of this strategy remains an area of controversy. In older adults, the etiology is usually attributed to carotid stenosis, intracranial stenosis associated with hypertension, and cardioembolic from atrial fibrillation. A rare indication for PFO closure absent stroke or TIA is the patient with orthodeoxia-platypnea syndrome as a result of right to left flow at the ASD. The Amplatzer Septal Occluder (ASO) is made from a winding of nitinol wire creating two disks and a central waist with polyester fabric disks sewn into the mesh to create an occluding surface. The Amplatzer Cribiform Septal Occluder is a modified version of the ASO designed to close multifenestrated ASD.