针对经选择患者组全部患者的治疗推荐
对尽管接受内科治疗但仍出现复发性 DVT 和复发性隐源性卒中的特定病例[21]Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160-1236.http://stroke.ahajournals.org/content/45/7/2160.longhttp://www.ncbi.nlm.nih.gov/pubmed/24788967?tool=bestpractice.com、职业潜水员以及深潜时有减压病症状的患者，应根据具体情况考虑是否进行 PFO 经皮封堵术。[25]National Institute for Health and Care Excellence. Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent paradoxical embolism in divers. December 2010. https://www.nice.org.uk/guidance/ (last accessed 20 September 2016).https://www.nice.org.uk/guidance/ipg371宇航员是否需要接受封堵术尚不明确。目前，不建议对隐源性卒中患者常规采用经皮封堵术。[21]Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160-1236.http://stroke.ahajournals.org/content/45/7/2160.longhttp://www.ncbi.nlm.nih.gov/pubmed/24788967?tool=bestpractice.com如果 PFO 是在因搭桥手术或心脏瓣膜手术等其他适应症而进行的开放式心脏手术中发现的，则应采用开放式手术（进行修补）。
需要随机试验数据比较药物治疗与器械治疗，[29]O'Gara PT, Messe SR, Tuzcu EM, et al. Percutaneous device closure of patent foramen ovale for secondary stroke prevention: a call for completion of randomized clinical trials: a science advisory from the American Heart Association/American Stroke Association and the American College of Cardiology Foundation. Circulation. 2009;119:2743-2747.http://circ.ahajournals.org/cgi/content/full/119/20/2743http://www.ncbi.nlm.nih.gov/pubmed/19433754?tool=bestpractice.com但入组情况较差。一项随机对照试验显示，内科治疗与 Amplatzer 器械封堵无差异。[32]Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013;368:1083-1091.http://www.ncbi.nlm.nih.gov/pubmed/23514285?tool=bestpractice.com有一些数据表明，对其接受器械封堵术治疗的患者，其心房颤动的发病率可能会下降，[33]Jarral OA, Saso S, Vecht JA, et al. Does patent foramen ovale closure have an anti-arrhythmic effect? A meta-analysis. Int J Cardiol. 2011;153:4-9.http://www.ncbi.nlm.nih.gov/pubmed/21420189?tool=bestpractice.com[34]Khan AR, Bin Abdulhak AA, Sheikh MA, et al. Device closure of patent foramen ovale versus medical therapy in cryptogenic stroke: a systematic review and meta-analysis. JACC Cardiovasc Interv. 2013;6:1316-1323.http://www.ncbi.nlm.nih.gov/pubmed/24139929?tool=bestpractice.com[35]Kitsios GD, Thaler DE, Kent DM. Potentially large yet uncertain benefits: a meta-analysis of patent foramen ovale closure trials. Stroke. 2013;44:2640-2643.http://www.ncbi.nlm.nih.gov/pubmed/23868270?tool=bestpractice.com[36]Ntaios G, Papavasileiou V, Makaritsis K, et al. PFO closure vs. medical therapy in cryptogenic stroke or transient ischemic attack: a systematic review and meta-analysis. Int J Cardiol. 2013;169:101-105.http://www.ncbi.nlm.nih.gov/pubmed/24041984?tool=bestpractice.com[37]Wolfrum M, Froehlich GM, Knapp G, et al. Stroke prevention by percutaneous closure of patent foramen ovale: a systematic review and meta-analysis. Heart. 2014;100:389-395.http://www.ncbi.nlm.nih.gov/pubmed/23793373?tool=bestpractice.com而汇总分析提示，心房颤动的风险增加。[38]Li J, Liu J, Liu M, Zhang S, et al. Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack. Cochrane Database Syst Rev. 2015;(9):CD009938.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009938.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26346232?tool=bestpractice.com[39]Kent DM, Dahabreh IJ, Ruthazer R, et al. Device closure of patent foramen ovale after stroke: pooled analysis of completed randomized trials. J Am Coll Cardiol. 2016;67:907-917.http://www.ncbi.nlm.nih.gov/pubmed/26916479?tool=bestpractice.com
对现有封堵器进行比较的数据有限，但是研究表明 Amplatzer 封堵器性能较优。[26]Hornung M, Bertog SC, Franke J, et al. Long-term results of a randomized trial comparing three different devices for percutaneous closure of a patent foramen ovale. Eur Heart J. 2013;34:3362-3369.http://eurheartj.oxfordjournals.org/content/34/43/3362.longhttp://www.ncbi.nlm.nih.gov/pubmed/23842846?tool=bestpractice.com[27]Li Y, Zhou K, Hua Y, et al. Amplatzer occluder versus CardioSEAL/STARFlex occluder: a meta-analysis of the efficacy and safety of transcatheter occlusion for patent foramen ovale and atrial septal defect. Cardiol Young. 2013;23:582-596.http://www.ncbi.nlm.nih.gov/pubmed/23199453?tool=bestpractice.com
经皮封堵术之前，患者接受抗血小板或抗凝治疗。
PFO 封堵术之后，通常建议进行 3 个月的抗血小板治疗。
