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.

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• Any young patient with unexplained brain MRI changes consistent with ischaemia.

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• Migraine with aura patients who you consider are:

  1. significantly debilitated

  2. experience a major lifestyle impact

  3. failure of standard medical therapy due to intolerance or a poor efficacious response

  4. Aura with hemiplegia or blindness

• Commercial diver or any diver with migraine or previous decompression illness

• Unexplained dyspnoea