European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

Christian Pristipino, Peter Germonpré, Danilo Toni, Horst Sievert, Bernhard Meier, Fabrizio D'Ascenzo, Sergio Berti, Eustaquio Maria Onorato, Francesco Bedogni, Jean Louis Mas, Paolo Scacciatella, David Hildick-Smith, Fiorenzo Gaita, Paul A. Kyrle, John Thomson, Genevieve Derumeaux, DIrk Sibbing, Massimo Chessa, Marius Hornung, Jose ZamoranoDariusz Dudek, Fabrizio D'Ascenzo, Pierluigi Omedè, Flavia Ballocca, Umberto Barbero, Francesca Giordana, Sebastiano Gili, Mario Iannaccone, Teiji Akagi, Gianpaolo Anzola, John Carroll, Bharat Dalvi, Claudio De Angelis, Ge Junbo, Scott E. Kasner, Ina Michel-Behnke, Giuseppe Musumeci, Lars Søndergaard, Giuseppe Tarantini, Giuseppe G.L. Biondi-Zoccai, Davide Capodanno, Marco Valgimigli, Robert Byrne, Vijay Kunadian

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.

Original languageEnglish
Pages (from-to)1545-1553
Number of pages9
JournalEuropean Heart Journal
Volume42
Issue number16
DOIs
Publication statusPublished - Apr 21 2021
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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