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Patent foramen ovale

INTRODUCTION

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 "Pathophysiology and clinical features 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".)

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 [4]:

  • Probe-patent PFO was present in 27 percent; the prevalence and size was similar in males and females.
  • The prevalence of PFO declined progressively with age, from 34 percent up to age 30, to 25 percent between ages 30 and 80, to 20 percent over age 80.
  • Among patients who have a PFO, the mean size increased progressively with age, from 3.4 mm up to age 10 to 5.8 mm over age 90. This trend may reflect size selection as larger defects remain patent while smaller defects close spontaneously.
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