{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T17:15:15Z","timestamp":1778087715523,"version":"3.51.4"},"reference-count":11,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Implementing this activity required meeting national regulatory volume thresholds and developing specific protocols. Key challenges included establishing \u201cremote anesthesia\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009=\u20095 at 6 months) demonstrate a 100% complete sealing rate. For divers, a specific \u201cReturn to Duty\u201d algorithm was formalized, strictly conditioning operational clearance upon a 6-month \u201cSafety Visa\u201d (contrast echocardiography and stress test), allowing for a zero-medication return to work.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The internalization of PFO closure at a Role 4 military hospital validates a comprehensive \u201cDual-Use\u201d 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag218","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:44:22Z","timestamp":1777031062000},"source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4709-373X","authenticated-orcid":false,"given":"Thibaut","family":"Prevautel","sequence":"first","affiliation":[{"name":"Department of Cardiology, Sainte-Anne Military Teaching Hospital (HIA Sainte-Anne) , Toulon 83000,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael","family":"Demoulin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sainte-Anne Military Teaching Hospital (HIA Sainte-Anne) , Toulon 83000,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sainte-Anne Military Teaching Hospital (HIA Sainte-Anne) , Toulon 83000,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gwenole","family":"Rohel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sainte-Anne Military Teaching Hospital (HIA Sainte-Anne) , Toulon 83000,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonore","family":"Capilla","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sainte-Anne Military Teaching Hospital (HIA Sainte-Anne) , Toulon 83000,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Pons","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sainte-Anne Military Teaching Hospital (HIA Sainte-Anne) , Toulon 83000,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alisson","family":"Adet","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sainte-Anne Military Teaching Hospital (HIA Sainte-Anne) , Toulon 83000,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilles R","family":"Cellarier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sainte-Anne Military Teaching Hospital (HIA Sainte-Anne) , Toulon 83000,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"2026050612560524800_usag218-B1","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1016\/j.acvd.2019.06.002","article-title":"Transcatheter closure of patent foramen ovale to prevent stroke recurrence in patients with otherwise unexplained ischaemic stroke: expert consensus of the French Neurovascular Society and the French Society of Cardiology","volume":"112","author":"Mas","year":"2019","journal-title":"Arch Cardiovasc Dis"},{"key":"2026050612560524800_usag218-B2","first-page":"2","article-title":"Pathophysiology, prevention and management of decompression illness in divers with a right-to-left shunt","volume":"52","author":"Smart","year":"2022","journal-title":"Diving Hyperb Med"},{"key":"2026050612560524800_usag218-B3","first-page":"599","article-title":"Thevenin-Garron V. Incidence of thirty chronic diseases in the French armed forces between 2005 and 2011","volume":"25","author":"Martinez","year":"2013","journal-title":"Sant\u00e9 Publique"},{"key":"2026050612560524800_usag218-B4","doi-asserted-by":"publisher","first-page":"100039","DOI":"10.1016\/j.jscai.2022.100039","article-title":"SCAI guidelines for the management of patent foramen ovale","volume":"1","author":"Kavinsky","year":"2022","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"2026050612560524800_usag218-B5","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1177\/23969873241247978","article-title":"European Stroke Organisation (ESO) guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke","volume":"9","author":"Caso","year":"2024","journal-title":"Eur Stroke J"},{"key":"2026050612560524800_usag218-B6","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s11936-019-0775-7","article-title":"Role of PFO closure in ischemic stroke prevention","volume":"21","author":"Osteraas","year":"2019","journal-title":"Curr Treat Options Cardiovasc Med"},{"key":"2026050612560524800_usag218-B7","first-page":"1769","article-title":"Percutaneous closure of patent foramen ovale in divers: long-term risk of decompression illness","volume":"14","author":"Torti","year":"2019","journal-title":"EuroIntervention"},{"key":"2026050612560524800_usag218-B8","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.accpm.2015.01.004","article-title":"Guidelines on the use of ultrasound guidance for vascular access","volume":"34","author":"Bouaziz","year":"2015","journal-title":"Anaesth Crit Care Pain Med"},{"key":"2026050612560524800_usag218-B9","author":"Autorit\u00e9 de Sant\u00e9","year":"2023"},{"key":"2026050612560524800_usag218-B10","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1093\/ehjcvp\/pvad023","article-title":"Impact of the antiplatelet strategy following patent foramen ovale percutaneous closure","volume":"9","author":"Guedeney","year":"2023","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"2026050612560524800_usag218-B11","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jcin.2019.09.042","article-title":"Effect of residual interatrial shunt on migraine burden after transcatheter closure of patent foramen ovale","volume":"13","author":"BenAssa","year":"2020","journal-title":"JACC Cardiovasc Interv"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag218\/68231652\/usag218.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag218\/68231652\/usag218.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:56:11Z","timestamp":1778086571000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag218\/8671289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":11,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag218","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,6]]},"article-number":"usag218"}}