Atrial septal abnormalities (PFO, ASD, and ASA) and risk of cerebral emboli in adults
- Steven R Messé, MD
Steven R Messé, MD
- Associate Professor of Neurology
- Hospital of the University of Pennsylvania
- Naser M Ammash, MD
Naser M Ammash, MD
- Professor of Medicine
- Mayo Medical School
- Section Editors
- Scott E Kasner, MD
Scott E Kasner, MD
- Section Editor — Stroke
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Heidi M Connolly, MD, FASE
Heidi M Connolly, MD, FASE
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
Stroke can be associated with abnormalities of the atrial septum, specifically patent foramen ovale (PFO), atrial septal defect (ASD), and atrial septal aneurysm (ASA).
The relationship between PFO, ASD, or ASA and ischemic neurologic complications will be reviewed here. Treatment is reviewed separately. (See "Treatment of atrial septal abnormalities (PFO, ASD, and ASA) for prevention of stroke in adults".)
PFO AND ATRIAL SEPTAL DEFECT
The foramen ovale and its flap-like valve between the right and left atrium are important components of the fetal circulation. In the developing fetus, oxygenated blood from the umbilical vein enters the right atrium via the inferior vena cava and is shunted into the left atrium, circumventing the noninflated lungs. After birth, a relative increase in left atrial pressure closes the flap, and adhesions frequently result in a structurally intact atrial septum. However, in approximately 25 percent of adults, the foramen ovale remains patent and acts as a potential interatrial shunt (movie 1 and movie 2). (See "Patent foramen ovale".)
Less commonly, an open communication called an atrial septal defect (ASD) persists between the atria after septation. The majority of these are secundum ASD defects caused by deficiency in the septum primum. This may be visualized on transthoracic (movie 3 and movie 4) or transesophageal echocardiography (movie 5).
The pathophysiology and clinical features of PFOs and atrial septal defects are discussed in detail separately. (See "Clinical manifestations and diagnosis of atrial septal defects in adults", section on 'Classification' and "Clinical manifestations and diagnosis of atrial septal defects in adults", section on 'Embryology'.)
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- PFO AND ATRIAL SEPTAL DEFECT
- SOURCES OF EMBOLI
- Paradoxical emboli
- - Right-sided sources
- - Right-to-left shunting
- Atrial septal aneurysm
- Left-sided sources
- RISK OF EMBOLIC STROKE
- Case-control studies
- - Risk factors
- - PFO characteristics
- Prospective studies
- Population-based studies
- Cardiac evaluation
- Source of the embolus
- INFORMATION FOR PATIENTS