Patent foramen ovale
- Hidehiko Hara, MD
Hidehiko Hara, MD
- Associate Professor
- Division of Cardiovascular Medicine
- Toho University Ohashi Medical Center
- Robert S Schwartz, MD, FACC
Robert S Schwartz, MD, FACC
- Medical Director
- Minneapolis Heart Institute and Foundation
Patent foramen ovale (PFO) is a congenital cardiac lesion that frequently persists into adulthood [1-3]. Although most patients with a PFO are asymptomatic, a variety of clinical manifestations may be associated with PFO, most importantly cryptogenic stroke. (See 'Clinical manifestations' below.)
Issues related to the prevalence, anatomy, associations with other defects, clinical manifestations, and detection of PFO will be reviewed here. Clinical manifestations of atrial septal defects, including PFO, and the indications for and techniques of closure of a PFO are discussed separately. (See "Clinical manifestations and diagnosis of atrial septal defects in adults" and "Atrial septal abnormalities (PFO, ASD, and ASA) and risk of cerebral emboli in adults" and "Treatment of atrial septal abnormalities (PFO, ASD, and ASA) for prevention of stroke in adults" and "Classification of atrial septal defects (ASDs), and clinical features and diagnosis of isolated ASDs in children" and "Management and outcome of isolated atrial septal defects in children".)
PREVALENCE AND PATHOPHYSIOLOGY
Patent foramen ovale (PFO) was found in 25 to 30 percent of individuals in an autopsy study and in a community-based transesophageal echocardiography (TEE) study [4,5].
The following findings were noted in the autopsy study of 965 normal hearts :
●Probe-patent PFO was present in 27 percent; the prevalence and size were similar in males and females.
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- Nusser T, Höher M, Merkle N, et al. Cardiac magnetic resonance imaging and transesophageal echocardiography in patients with transcatheter closure of patent foramen ovale. J Am Coll Cardiol 2006; 48:322.
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- PREVALENCE AND PATHOPHYSIOLOGY
- ASSOCIATION WITH OTHER DEFECTS
- Atrial septal aneurysm
- Eustachian valve and Chiari network
- Atrial septal defect
- Ebstein's anomaly
- CLINICAL MANIFESTATIONS
- Cryptogenic stroke
- Migraine and vascular headache
- Decompression sickness and air embolism
- Platypnea-orthodeoxia syndrome
- Ultrasound techniques
- - TEE, TTE, and ICE
- - Transmitral Doppler
- - Transcranial Doppler
- - Safety
- MDCT and CMR
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS