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

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.