While early studies showed no benefit from patent foramen ovale (PFO) closure to prevent stroke recurrence in adults, more recent studies show benefit, particularly for patients with larger PFO, atrial septal aneurysm, and hypermobility of the interatrial septum. It is likely that stroke due to paradoxical embolism of venous thrombosis can occur in children as well; however, PFO is common in children and the role of PFO and PFO closure in childhood stroke is unknown. Nevertheless, based on data in adults, PFO closure is being performed in children for secondary stroke prevention.

A broad search using diagnostic codes for stroke were used to identify all children at a single institution between 1 month and 18 years of age with acute arterial ischemic stroke occurring in an 11-year period. Characteristics of patients with cryptogenic stroke ascribed to PFO are described.

Among 215 children with arterial ischemic stroke, 25 (12%) had cryptogenic stroke.  Among these, 10 (5% of total, 6 males) had PFO closure performed, 7 through the local pediatric stroke program and 3 prior to referral.  Age at time of stroke ranged from 9-18 years (median 14.5 years).  Five had anterior circulation stroke and 5 had posterior circulation stroke.  Four performed a Valsalva maneuver prior to stroke ictus.  Five had hereditary thrombophilias (elevated lipoprotein a in three, heterogenous factor V Leiden in one, elevated homocysteine in one). Three of the 4 females were taking exogenous estrogen. PFO size at closure was known for 8 patients, range 7-12 mm (median 10 mm).