The effect of patent foramen ovale closure on visual aura without headache or typical aura with migraine headache
JACC Cardiovascular Interventions, 06/22/2012

Khessali H et al. – The similar distribution of R to L shunting in all 3 patient groups and the correlation between patent foramen ovale (PFO) closure and improvement of aura suggests a similar pathophysiology between the presence of PFO and the visual aura phenomenon, whether or not headache is present in the symptom complex.

• Of patients referred to the University of California, Los Angeles for suspected patent foramen ovale (PFO), 225 had visual aura with or without MH.
• Patients were assessed for a shunt and evaluated for MH and/or visual aura.
• They were divided into 3 groups:
• 1) visual aura associated with MH;
• 2) visual aura unrelated in time to MH;
• And visual aura without MH.
• The frequency of R to L shunt was compared with a control group of 200 patients.
• Eighty patients underwent PFO closure.
• Residual shunts, MH, and visual aura were reassessed after 3 and 12 months.

• The prevalence of R to L shunt in Groups A, B, and C was 96%, 72%, and 67%, respectively, versus 18% in the control group (p < 0.0001).
• The frequency of shunting was similar in Group B versus Group C, but much higher in all 3 groups compared with control subjects.
• Twelve months after PFO closure, symptoms of aura were resolved in 52%, 75%, and 80% of patients in Groups A, B, and C, respectively (p = NS).