To close or not to close: PFO, sex and cerebrovascular events.

We report on 2 patients with cerebrovascular events associated with sexual activity and PFO who subsequently underwent endovascular patent foramen ovale (PFO) closure. The concurrence of sexual activity (a Valsalva equivalent) at symptom onset, together with supporting data, prior paradoxical embolus in 1 case, elevated D-dimer in another, supported paradoxical embolization as the most likely mechanism of the cerebrovascular events. These cases emphasize that clinicians evaluating patients for PFO closure should explicitly inquire about sexual activity at stroke onset.