Patent Foramen Ovale and Pregnancy: A Case Report and Literature Review

TL;DR

A pregnant woman with a heart condition called PFO experienced a stroke, and her case highlights the importance of careful management and timing of treatment.

Contribution

This case report emphasizes the value of using the RoPE score and deferring PFO closure until after pregnancy in selected patients.

Findings

A large right-to-left shunt via PFO was confirmed as the likely cause of stroke in a pregnant woman.

Anticoagulation and postpartum PFO closure led to favorable neurological recovery.

Deferring intervention until postpartum aligns with current guidelines and may be safer in selected cases.

Abstract

Patent foramen ovale (PFO) is a common congenital cardiac anomaly that can serve as a conduit for paradoxical embolism, particularly in young patients with cryptogenic stroke. Pregnancy induces a hypercoagulable state that may unmask underlying predisposing conditions such as PFO. Although ischemic stroke during pregnancy is rare, it carries significant maternal and neonatal complications.

We report the case of a young woman in her third trimester who presented with an acute ischemic stroke. Initial diagnostic evaluation using transthoracic echocardiography (TTE) with a bubble study confirmed the presence of a PFO, characterized by a large right-to-left shunt. The Risk of Paradoxical Embolism (RoPE) score was high, suggesting a strong likelihood that the PFO was causally related to the stroke. No alternative etiology was identified after thorough investigation.

She was managed with anticoagulation therapy, with input from a multidisciplinary team including neurology, cardiology, and maternal-fetal medicine specialists. Postpartum, she underwent successful percutaneous PFO closure with a Gore Cardioform device (W. L. Gore & Associates, Inc., Newark, DE), with follow-up imaging revealing minimal residual shunting and favorable neurological recovery.

This case highlights the importance of considering PFO as a potential cause of stroke during pregnancy. It underscores the need for individualized management guided by anatomical characteristics and validated clinical scoring systems such as the RoPE score. In contrast to some prior reports advocating early closure, this case supports deferring intervention until postpartum in selected patients, aligning with current guidelines that recommend a cautious approach during pregnancy.

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