Atrial septal aneurysms (ASA; Fig. 3) are associated with PFO. ASA incidence is approximately 1% by autopsy and 2% by TEE. PFO was diagnosed in 70% of stroke patients with an ASA and 75% of controls with an ASA. An ASA is common in patients with unexplained stroke and is more frequently detected by TEE than by transthoracic echocardiography. An ASA in the absence of a PFO appears to be benign and interventional repair is usually not warranted.
A. Clinical Study: Martin Braun et al.
Study question: This study investigates the safety of transcatheter closure in PFO patients with cryptogenic cerebral ischemia and mid-term follow up of thromboem¬bolic events after closure.
Methods: In this study, 276 consecutive patients with TIA and a history of at least one thromboembolic event had percutaneous PFO closure with the PFO-Star Occluder (see Fig. 5). The mean age of patients was 45 i 13.7 years, 201 with stroke, and 273 with TIA.
Results: Implantation was successful in all 276 patients. During a 15-month follow up the annual recurrence rate of thromboembolic events was 1.7% for TIA, 0% for stroke, and 0% for peripheral emboli.
Conclusion: The authors of the study concluded that interventional PFO closure with the PFO-Star Occluder device appears to be a promising technique, which results in a low recurrence rate of thromboembolic events in patients with cryptogenic ischemia presumably due to paradoxical embolization. Note that the authors used the word presumably. In a study by Hung et al., a 56-year-old patient had a stroke 6 months following device placement that was well seated without residual shunting.

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