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Atrial septal abnormalities (PFO, ASD, and ASA) and risk of cerebral emboli in adults

Steven R Messé, MD
Naser M Ammash, MD
Section Editors
Scott E Kasner, MD
Heidi M Connolly, MD, FASE
Deputy Editors
John F Dashe, MD, PhD
Susan B Yeon, MD, JD, FACC


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".)


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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Literature review current through: Sep 2017. | This topic last updated: Apr 13, 2016.
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