Implementation of a Patent Foramen Ovale Closure Program in a Role 4 Military Hospital: Initial Experience and Proof-of-Concept for Enhancing Cryptogenic Stroke Care and Military Diving Operational Readiness

Abstract Introduction The Sainte-Anne Military Teaching Hospital in Toulon serves a dual mission as a civilian Stroke Center and a reference center for military diving medicine. This article presents an initial experience and proof-of-concept regarding the implementation of an on-site percutaneous Patent Foramen Ovale (PFO) closure program, critical for secondary stroke prevention and the management of decompression sickness (DCS). Materials and Methods Implementing this activity required meeting national regulatory volume thresholds and developing specific protocols. Key challenges included establishing “remote anesthesia” in the catheterization laboratory and coordinating a multidisciplinary pathway. To ensure patient safety and rapid skill acquisition, structural cardiology protocols adhered strictly to international proctoring guidelines. Results A comprehensive care pathway was successfully established. In its first year, the program performed 17 PFO closures (13 cryptogenic strokes, 3 DCS, 1 platypnea-orthodeoxia), achieving a 100% immediate anatomical success rate with zero complications. Early follow-up data (n = 5 at 6 months) demonstrate a 100% complete sealing rate. For divers, a specific “Return to Duty” algorithm was formalized, strictly conditioning operational clearance upon a 6-month “Safety Visa” (contrast echocardiography and stress test), allowing for a zero-medication return to work. Conclusions The internalization of PFO closure at a Role 4 military hospital validates a comprehensive “Dual-Use” care model. It ensures operational readiness for elite units by securing the pathway from diagnosis to anatomical repair, while utilizing high-volume civilian stroke care to maintain expert-level technical proficiency.