Patent Foramen Ovale And Stroke In Adolescents - To Close Or Not To Close?

Stroke is a rare condition in childhood and about half of the cases are due to an arterial ischemic event. Although the long list of known causes, many cases remain undetermined, so-called cryptogenic strokes. However, increasing evidence indicates that some of these cryptogenic cases can be a result of a paradoxical embolism via a Patent Foramen Ovale (PFO) with a right-to-left intracardiac shunt, but the exact contribution of PFO to stroke or stroke recurrence in childhood remains unclear. Considering this, as a second line of study, a transthoracic and transoesophageal echocardiogram should be done in all cases to rule out a possible right-to-left shunt, such as PFO. Optimal treatment for acute ischemic strokes in children is con-troversial, with lacking studies. Closure of PFO should be considered as a preventive measure depending on individual risk factors and anatomic features. We present two cases of a 16-year-old boy and a 17-year-old girl who had an event of cerebral ischemia documented on MRI, and in whom was found a PFO with a shunt, with the remaining exhaustive etiologic investigation all negative. Both of them underwent percutaneous closure of the PFO.