CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 38 AFRICA anticoagulant drug therapy or implantation of a second closure device.23-25 The optimal management needs to be determined based on the individual patient, taking into account the risk of a repeat procedure, other risk factors for stroke (hypertension, AF, atherosclerotic cardiovascular disease) and bleeding risk. Surgical PFO closure The majority of PFOs are closed by percutaneous technique. Where a PFO is deemed unsuitable for percutaneous device closure, surgical closure is deemed appropriate in a patient less than 60 years of age and with cryptogenic stroke. However, the efficacy of surgical closure of PFO for cerebrovascular accident has been variable and there are no large, randomised trials comparing surgical closure versus device closure versus medical therapy.26-28 Conclusion PFO closure is indicated in patients with cryptogenic stroke when the balance of probabilities favours that a paradoxical embolism is the cause. Percutaneous closure with a PFO occluder is the preferred intervention and the procedural risk must be kept as low as possible. There is little evidence for PFO closure in other clinical conditions. References 1. Koutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayiotides T. Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review. Frontiers in Neurol 2020; 11: 281. 2. Ziegler PD, Rogers JD, Ferreira SW, Nichols AJ, Sarkar S, Koehler JL, et al. Real-world experience with insertable cardiac monitors to find atrial fibrillation in cryptogenic stroke. 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