Who is suitable for PFO assessment?
Any young patient who has had a thromboembolic event without an obvious cause such as atherosclerosis and major CV risk factors. Specifically CVA/TIA, amourosis fugax, myocardial infarct, peripheral or any central embolic event such as mesenteric ischaemia and renal infarction.
NB: Remember Atrial Fibrillation occurs commonly in patients with atrial shunts and independently increases the thromboembolic risk.
Any young patient with unexplained brain MRI changes consistent with ischaemia.
Migraine with aura patients who you consider are:
experience a major lifestyle impact
failure of standard medical therapy due to intolerance or a poor efficacious response
Aura with hemiplegia or blindness
Commercial diver or any diver with migraine or previous decompression illness