Percutaneous PFO closure, further data but many unanswered questionsThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

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This editorial refers to ‘Patent foramen ovale closure in patients with cryptogenic thrombo-embolic events using the Cardia PFO occluder’† by C. Spies et al ., on page 365 The pace of technological development in interventional congenital cardiology over the last two decades has been fast and relentless. Successful and reliable closure of secundum atrial septal defects in the catheter laboratory translated to interest in the use of similar devices for the occlusion of the patent foramen ovale (PFO), a common remnant of the fetal circulation. The pathological potential of the PFO in the genesis of unexplained thrombotic stroke had long been suspected,1 with Lechat et al. 2 in 1988 reporting a higher prevalence of PFO in patients with cryptogenic thrombotic stroke, an observation confirmed in a number of subsequent studies.3 With low risk and a simple technique for PFO closure as an alternative to surgery, many clinicians faced with patients affected by crypotogenic stroke have been quick to advance the cause of percutaneous therapy in this setting, despite the lack of a really robust evidence base. As a result, we have found ourselves in a scenario familiar to many involved with transcatheter intervention in congenital heart disease where technological advances and the ability to perform a procedure have to some degree outpaced our understanding … *Corresponding author. Tel: +44 113 3928184; fax: +44 113 3928375. E-mail address : john.thomson{at}lineone.net