所有患者
在接受药物治疗的患者中,PFO 与复发性卒中或死亡风险较高无关。但是,罹患 PFO 和房间隔动脉瘤的 55 岁以下患者中,复发性卒中的风险较高。
存在小缺损的无症状患者
PFO 极其常见,经常是被偶然发现的,预后良好。无正式研究可用。
大 PFO 和有 TIA 或卒中既往史的患者
PFO 患者在无其他明显诱因情况下出现复发性卒中或 TIA 的风险增高了 3 倍,而 PFO 和房间隔动脉瘤患者的风险则增高了 6 倍(每年 3%)。[11]Mas JL, Zuber M. Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack. Am Heart J. 1995;130:1083-1088.http://www.ncbi.nlm.nih.gov/pubmed/7484740?tool=bestpractice.com[41]Bogousslavsky J, Garazi S, Jeanrenaud X, et al. Stroke recurrence in patients with patent foramen ovale: the Lausanne study. Neurology. 1996;46:1301-1305.http://www.ncbi.nlm.nih.gov/pubmed/8628471?tool=bestpractice.com[42]Stone DA, Godard J, Corretti MC, et al. Patent foramen ovale: association between the degree of shunt by contrast transesophageal echocardiography and the risk of future ischemic neurologic events. Am Heart J. 1996;131:158-161.http://www.ncbi.nlm.nih.gov/pubmed/8554004?tool=bestpractice.com但是,已接受治疗的患者中,复发性卒中或 TIA 的绝对风险相对较低。[43]Mohr JP, Thompson JL, Lazar RM, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001;345:1444-1451.http://www.nejm.org/doi/full/10.1056/NEJMoa011258#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/11794192?tool=bestpractice.com
经皮封堵术后
复发性卒中或 TIA 风险较低但不能忽略不计。[44]Hung J, Landzberg MJ, Jenkins KJ, et al. Closure of patent foramen ovale for paradoxical emboli: intermediate-term risk of recurrent neurological events following transcatheter device placement. J Am Coll Cardiol. 2000;35:1311-1316.http://www.ncbi.nlm.nih.gov/pubmed/10758974?tool=bestpractice.com[45]Homma S, Di Tullio MR, Sacco RL, et al. Surgical closure of patent foramen ovale in cryptogenic stroke patients. Stroke. 1997;28:2376-2381.http://stroke.ahajournals.org/cgi/content/full/28/12/2376http://www.ncbi.nlm.nih.gov/pubmed/9412617?tool=bestpractice.com