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[Patent foramen ovale, aneurysm of the interatrial septum and cerebral ischemic complication].

Persistence of a patent foramen ovale (PFO) and the presence of an aneurysm of the interatrial septum (AIAS) are significantly more frequent in patients examined for cerebral ischaemic accident of unknown cause than in control subjects. The mechanism of ischaemic accidents associated with these cardiac abnormalities (frequently associated with each other), particularly the frequency of paradoxical embolism, remains unclear. In young patients, the risk of recurrent cerebral ischaemic accident appears to be generally low (1 to 2% per year). Secondary prevention remains empirical and controversial. No comparative studies are available to demonstrate the superiority of platelet antiaggregants, oral anticoagulants or invasive treatments, such as endovascular or surgical closure of the foramen ovale. A rational treatment can only be proposed on the basis of a better understanding of the natural history of ischaemic recurrences (identification of subgroups of patients at high or low risk of recurrence) and the therapeutic benefit risk ratio.