Once in a while you pick up the latest journal. It doesn't happen that often, but your heart just sinks.

And this was one of those weeks where I have told patients in the past with a patent forminal valley and a cryptogenic stroke that they should not get closure of their patent forminal valley.

And I think that was indeed the standard of care.

In fact, I've gone back to a few resources to make sure that was absolutely correct.

And so I think that's probably what most colleagues were saying who had patients with a

paid informant ovale and a cryptogenic stroke.

We weren't saying don't treat it at all. We were saying you must

be on an anti-platelet or an anticoagulant therapy. So backing up before we get to these new studies,

a form in Ovali, it's present to allow transfer of oxygen in placental blood in the fetal circulation.

And then when you're born, it closes. So it doesn't close in every single person, and it takes

a while sometimes, meaning it takes a few weeks of life for the patent forminal valley to close.

And when that forminal valley does not close, which happens

in about 25% to 30% of the population, then you have a patent form in ovale. And if you're

totally asymptomatic from that, and it just happens to be picked up, no big deal.

We usually did not do anything about that.

And that's actually still the case.

I don't know of situations where we close paid informant ovallies if you're a totally asymptomatic

person.

Now there have been times where this has been looked at,

for instance, in migraine patients where they thought maybe there's an association between a PFO,

and that's a PORMENT form in a migraine. However, when they looked at closing the PFO, there didn't

seem to be any benefit.

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