Introduction
PFO, congenital heart disease, ischemic strokes, epileptic seizures, RLS, epilepsy, stroke, Patent foramen ovale, patent foramen ovale, dementia, heart abnormality, Epilepsy, migraine
NEUROLOGICAL DISEASE, ISCHEMIC STROKES, EPILEPSY, STROKE, EPILEPTIC SEIZURE, WEST, EPILEPSY, MIGRAINE, EVENTS, CNS DISEASES
Patent foramen ovale (PFO) is the most prevalent congenital heart abnormality of fetal origin, affecting approximately 25% of people worldwide [
Schematic diagram of blood circulation in patients with patent foramen ovale before (Fig. 1a) and after birth (Fig. 1b). Note: PVR, pulmonary vascular resistance; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventriclePrior to the introduction of percutaneous transcatheter closure, traditional surgical therapy was the primary method for PFO closure and was associated with low sealing effectiveness and numerous problems. The first case series documenting successful percutaneous transcatheter closure of PFO in 36 patients was published in 1992 [
Schematic diagram of foramen ovale closure. Note: Local anaesthesia is first administered at the groin. The femoral vein is then punctured to facilitate venous access, followed by standard guide wire and catheter techniques to access the right side of the heart. Typically, closure of the patent foramen ovale (PFO) is accomplished by implantation of a self-expandable occluder under fluoroscopic as well as intracardiac echocardiography or transoesophageal echocardiography guidance. Periprocedural imaging of the PFO is not standard. The most widely used device to close the PFO is the double-disc-type occluder. The device catheter first crosses the PFO tunnel. The left-sided disk of the occluder is then completely unfolded and positioned at the left side of the interatrial septum. In a second step, the right-sided disk is unfolded and adopted to the right side of the septum. After verification of a secure and correct placement, the occluder is detached from the catheter and the remaining catheter material is retrieved. LA, left atrium; RA, right atriumIn recent years, PFO closure has demonstrated effectiveness and safety in individuals with certain CNS diseases, such as stroke and migraine, which co-occur with a high RLS grade of PFO. Long-term follow-up studies have shown that most patients who underwent PFO closure through catheter-based procedures were free from serious safety events and linked to a lower rate of recurrent ischemic strokes [Epilepsy affects over 69 million individuals worldwide and is one of the most common neurological diseases [As one of the top ten CNS diseases, epilepsy is closely associated with dementia, migraine, and stroke [To confirm this hypothesis, we did some preliminary work at the West China Hospital of Sichuan University, including screening PWE for the prevalence of PFO using contrast-enhanced transthoracic echocardiography, and observing the incidence of epilepsy in patients with PFO during long-term follow-up in a congenital heart disease cohort. We found that the PFO screening rate in PWE (38.69%) was higher than that in the general population (approximately 25%) [Based on this clinical evidence, we sought to perform a randomized clinical trial (RCT) using PFO closure to improve epileptic seizures in PRE accompanied by PFO of second-grade or higher RLS. We expect that this RCT would provide high-quality clinical evidence to verify our hypothesis and quantify the effectiveness and safety of PFO closure in these patients, laying the foundation for guiding clinical practice.