# Global research trends and frontiers in patent foramen ovale closure: a comprehensive bibliometric analysis (2004–2024)

## TL;DR

This study maps global research trends in patent foramen ovale closure, showing growth since 2017 and highlighting key areas like diagnosis, techniques, and outcomes.

## Contribution

A comprehensive bibliometric analysis of PFO closure research from 2004–2024, identifying emerging trends and key contributors.

## Key findings

- Annual publications on PFO closure increased significantly after 2017, driven by pivotal trial results.
- The U.S., Italy, and Germany led in research output, with institutions like the University of Bern and authors like Meier Bernhard playing central roles.
- Four major research clusters emerged: paradoxical embolism mechanisms, diagnostic imaging, closure techniques, and clinical outcomes.

## Abstract

Patent foramen ovale (PFO), present in 20–30% of the population, was once considered benign but is now recognized as a contributor to cryptogenic stroke and other clinical syndromes. Recent randomized trials and updated guidelines have established PFO closure as an effective intervention, leading to a surge in research. This study uses bibliometric analysis to evaluate global research trends, collaborations, and emerging hotspots in PFO closure.

We analyzed 927 English-language articles (2004–2024) from the Web of Science Core Collection using bibliometric tools (VOSviewer, CiteSpace, Bibliometrix R, online bibliometric analysis platforms). We systematically examined publication trends, contributions by countries and institutions, author networks, journal influence, and keyword clusters.

Annual publications increased significantly after 2017, coinciding with pivotal trial results. The United States (34.6%), Italy (16.8%), and Germany (11.5%) led in research output. Key institutions (e.g., University of Bern) and prominent authors (e.g., Meier Bernhard) played central roles. Four major research clusters were identified: mechanisms of paradoxical embolism, diagnostic imaging (e.g., transesophageal echocardiography), closure techniques (e.g., Amplatzer devices), and clinical outcomes. Burst detection revealed evolving priorities, including post-closure atrial fibrillation and improved patient selection (e.g., RoPE score).

Research on PFO closure has progressed from pathophysiological understanding to evidence-based clinical intervention, driven by landmark trials and multidisciplinary collaboration. Future directions include optimizing patient selection, managing post-procedural complications, and expanding indications (e.g., migraine). This analysis offers a roadmap for advancing stroke prevention strategies related to PFO.