A patent foramen ovale is a remnant of normal fetal anatomy. In most people, the foramen ovale naturally closes shortly after birth. However, in some individuals, the foramen ovale may remain partially or completely open, which is referred to as a patent foramen ovale. The patent foramen ovale itself is generally harmless and may go undetected for many years.
However, it has been associated with certain medical conditions and complications. One notable association is with cryptogenic strokes. Studies have suggested that a patent foramen ovale might play a role in allowing blood clots to travel from the veins to the arteries, potentially leading to strokes.
Additionally, a patent foramen ovale has been linked to certain other conditions, such as migraine headaches and decompression sickness in divers. The diagnosis of a patent foramen ovale is often made using imaging studies such as echocardiography. Treatment options may include medications to prevent blood clots or, in some cases, a procedure to close the PFO.
Epidemiology
The prevalence of a patent foramen ovale in the general population varies, and it is estimated that about 25-30% of adults have a patent foramen ovale. The incidence may be higher in certain populations, such as individuals who have experienced a cryptogenic stroke or those with certain medical conditions.
The association between PFO and cryptogenic strokes has led to increased interest in studying the epidemiology of PFO in specific patient populations. Studies have suggested that PFO is more common in individuals who have experienced a cryptogenic stroke compared to the general population.
The prevalence of PFO among individuals with cryptogenic stroke varies, with estimates ranging from about 40-50% or higher in some studies. Some studies suggest that the prevalence of PFO may decrease with advancing age. The prevalence of PFO does not seem to differ significantly between males and females.
Anatomy
Pathophysiology
The patent foramen ovale is a flap-like opening situated between the primum at the fossa ovalis and atrial septum secundum. During fetal development, it functions as a conduit for blood to access the systemic circulation. Following birth, as pulmonary circulation intensifies, the functional PFO gradually closes. Anatomical closure typically occurs around 12 months of age.
PFO is primarily associated with an elevated risk of stroke resulting from a paradoxical embolism. Larger defects and the presence of interatrial aneurysms augment the risk of cryptogenic stroke in individuals with PFO. This heightened risk may be attributed to an increased formation of in situ thrombus in the aneurysmal tissue or the tendency of PFOs associated with an interatrial septal aneurysm to be larger.
Although paradoxical embolism through a PFO has been reported in previous studies, its precise magnitude as a risk factor for stroke remains undefined. This uncertainty stems from the infrequent detection of deep venous thrombosis in such patients.
Notably, a study revealed a higher incidence of pelvic vein thrombi in young patients with cryptogenic stroke compared to those with a known cause of stroke. This observation implies a potential source of venous thrombi, especially when an initial identification of a venous thromboembolism source is lacking.
Etiology
The foramen ovale constitutes a tunnel-like passage between the superimposed septum secundum and septum primum. Approximately 75% of infants witness its closure upon the fusion of these septal structures. During fetal development, the foramen ovale plays a crucial role in facilitating blood flow across the atrial septum.
Oxygenated blood, originating from the placenta, returns to the inferior vena cava, traverses the foramen ovale, and is directed into the systemic circulation.
Genetic Factors: There may be a genetic predisposition to the persistence of the foramen ovale. Family history could play a role in the likelihood of having a patent foramen ovale.
Environmental Factors: Some environmental factors during fetal development might influence the closure of the foramen ovale. Exposure to certain substances or conditions could potentially contribute to the persistence of the opening.
Medical Conditions: Certain medical conditions or abnormalities in heart development may increase the likelihood of having a patent foramen ovale. For example, individuals with atrial septal defects may have a higher incidence of PFO.
Genetics
Prognostic Factors
In neonates and children, the prognosis for patent foramen ovale is highly favorable, with spontaneous closure occurring in the majority of cases. In instances where surgical closure becomes necessary in children and adults due to the risk of thromboembolism, the prognosis is generally positive, and surgical outcomes are well-documented. While percutaneous closure presents a promising alternative, it is important to note that complications are not uncommon in this approach.
Clinical History
PFO is often present at birth and is a normal part of fetal circulation. It should begin closing shortly after birth, with complete closure typically occurring by around 12 months of age. Many individuals remain asymptomatic throughout their lives. The presence of a PFO may be incidental and discovered during diagnostic testing for other health concerns.
Some individuals may experience migraine headaches, particularly migraine with aura. Symptoms can include severe headaches, visual disturbances, and sensitivity to light and sound. The onset of symptoms related to a cryptogenic stroke can vary, and individuals may experience a sudden or gradual onset of symptoms.
Migraine headaches associated with PFO may have variable onset and duration, with individuals experiencing episodic or chronic patterns. Some individuals may have a one-time event, while others may experience recurrent symptoms.
Physical Examination
The physical examination typically reveals no notable findings. A faint systolic murmur, attributed to turbulence in the flow across the foramen, may be detectable upon auscultation.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
In neonates and the pediatric demographic, the management and follow-up of patent foramen ovale are generally not required. PFO plays a crucial role in certain congenital heart conditions where blood shunting at the atrial level is essential.
In the adult population, the need for PFO treatment primarily arises in individuals experiencing cryptogenic strokes. Various approaches have been proposed for addressing this issue.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Several studies and trials have demonstrated that the percutaneous closure of patent foramen ovale using a device is more effective than medical therapy in reducing the risk of recurrence in patients under the age of 60. The Cardioseal Septal occlusion system and the Amplatzer PFO occluder have received FDA approval for percutaneous closure. The procedure is conducted with fluoroscopic guidance and necessitates hospital admission.
In cases where the PFO measures larger than 25 mm, fails to close through percutaneous methods, or exhibits an inadequate rim at the edge, making percutaneous closure challenging, a surgical approach is considered. Surgical closure ensures complete closure and eliminates the need for long-term anticoagulation. However, this approach requires open-heart surgery and entails the usual associated procedural risks.
A patent foramen ovale is a remnant of normal fetal anatomy. In most people, the foramen ovale naturally closes shortly after birth. However, in some individuals, the foramen ovale may remain partially or completely open, which is referred to as a patent foramen ovale. The patent foramen ovale itself is generally harmless and may go undetected for many years.
However, it has been associated with certain medical conditions and complications. One notable association is with cryptogenic strokes. Studies have suggested that a patent foramen ovale might play a role in allowing blood clots to travel from the veins to the arteries, potentially leading to strokes.
Additionally, a patent foramen ovale has been linked to certain other conditions, such as migraine headaches and decompression sickness in divers. The diagnosis of a patent foramen ovale is often made using imaging studies such as echocardiography. Treatment options may include medications to prevent blood clots or, in some cases, a procedure to close the PFO.
The prevalence of a patent foramen ovale in the general population varies, and it is estimated that about 25-30% of adults have a patent foramen ovale. The incidence may be higher in certain populations, such as individuals who have experienced a cryptogenic stroke or those with certain medical conditions.
The association between PFO and cryptogenic strokes has led to increased interest in studying the epidemiology of PFO in specific patient populations. Studies have suggested that PFO is more common in individuals who have experienced a cryptogenic stroke compared to the general population.
The prevalence of PFO among individuals with cryptogenic stroke varies, with estimates ranging from about 40-50% or higher in some studies. Some studies suggest that the prevalence of PFO may decrease with advancing age. The prevalence of PFO does not seem to differ significantly between males and females.
The patent foramen ovale is a flap-like opening situated between the primum at the fossa ovalis and atrial septum secundum. During fetal development, it functions as a conduit for blood to access the systemic circulation. Following birth, as pulmonary circulation intensifies, the functional PFO gradually closes. Anatomical closure typically occurs around 12 months of age.
PFO is primarily associated with an elevated risk of stroke resulting from a paradoxical embolism. Larger defects and the presence of interatrial aneurysms augment the risk of cryptogenic stroke in individuals with PFO. This heightened risk may be attributed to an increased formation of in situ thrombus in the aneurysmal tissue or the tendency of PFOs associated with an interatrial septal aneurysm to be larger.
Although paradoxical embolism through a PFO has been reported in previous studies, its precise magnitude as a risk factor for stroke remains undefined. This uncertainty stems from the infrequent detection of deep venous thrombosis in such patients.
Notably, a study revealed a higher incidence of pelvic vein thrombi in young patients with cryptogenic stroke compared to those with a known cause of stroke. This observation implies a potential source of venous thrombi, especially when an initial identification of a venous thromboembolism source is lacking.
The foramen ovale constitutes a tunnel-like passage between the superimposed septum secundum and septum primum. Approximately 75% of infants witness its closure upon the fusion of these septal structures. During fetal development, the foramen ovale plays a crucial role in facilitating blood flow across the atrial septum.
Oxygenated blood, originating from the placenta, returns to the inferior vena cava, traverses the foramen ovale, and is directed into the systemic circulation.
Genetic Factors: There may be a genetic predisposition to the persistence of the foramen ovale. Family history could play a role in the likelihood of having a patent foramen ovale.
Environmental Factors: Some environmental factors during fetal development might influence the closure of the foramen ovale. Exposure to certain substances or conditions could potentially contribute to the persistence of the opening.
Medical Conditions: Certain medical conditions or abnormalities in heart development may increase the likelihood of having a patent foramen ovale. For example, individuals with atrial septal defects may have a higher incidence of PFO.
In neonates and children, the prognosis for patent foramen ovale is highly favorable, with spontaneous closure occurring in the majority of cases. In instances where surgical closure becomes necessary in children and adults due to the risk of thromboembolism, the prognosis is generally positive, and surgical outcomes are well-documented. While percutaneous closure presents a promising alternative, it is important to note that complications are not uncommon in this approach.
PFO is often present at birth and is a normal part of fetal circulation. It should begin closing shortly after birth, with complete closure typically occurring by around 12 months of age. Many individuals remain asymptomatic throughout their lives. The presence of a PFO may be incidental and discovered during diagnostic testing for other health concerns.
Some individuals may experience migraine headaches, particularly migraine with aura. Symptoms can include severe headaches, visual disturbances, and sensitivity to light and sound. The onset of symptoms related to a cryptogenic stroke can vary, and individuals may experience a sudden or gradual onset of symptoms.
Migraine headaches associated with PFO may have variable onset and duration, with individuals experiencing episodic or chronic patterns. Some individuals may have a one-time event, while others may experience recurrent symptoms.
The physical examination typically reveals no notable findings. A faint systolic murmur, attributed to turbulence in the flow across the foramen, may be detectable upon auscultation.
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
In neonates and the pediatric demographic, the management and follow-up of patent foramen ovale are generally not required. PFO plays a crucial role in certain congenital heart conditions where blood shunting at the atrial level is essential.
In the adult population, the need for PFO treatment primarily arises in individuals experiencing cryptogenic strokes. Various approaches have been proposed for addressing this issue.
Several studies and trials have demonstrated that the percutaneous closure of patent foramen ovale using a device is more effective than medical therapy in reducing the risk of recurrence in patients under the age of 60. The Cardioseal Septal occlusion system and the Amplatzer PFO occluder have received FDA approval for percutaneous closure. The procedure is conducted with fluoroscopic guidance and necessitates hospital admission.
In cases where the PFO measures larger than 25 mm, fails to close through percutaneous methods, or exhibits an inadequate rim at the edge, making percutaneous closure challenging, a surgical approach is considered. Surgical closure ensures complete closure and eliminates the need for long-term anticoagulation. However, this approach requires open-heart surgery and entails the usual associated procedural risks.
medtigo
Patent foramen ovale
Updated :
November 18, 2023
A patent foramen ovale is a remnant of normal fetal anatomy. In most people, the foramen ovale naturally closes shortly after birth. However, in some individuals, the foramen ovale may remain partially or completely open, which is referred to as a patent foramen ovale. The patent foramen ovale itself is generally harmless and may go undetected for many years.
However, it has been associated with certain medical conditions and complications. One notable association is with cryptogenic strokes. Studies have suggested that a patent foramen ovale might play a role in allowing blood clots to travel from the veins to the arteries, potentially leading to strokes.
Additionally, a patent foramen ovale has been linked to certain other conditions, such as migraine headaches and decompression sickness in divers. The diagnosis of a patent foramen ovale is often made using imaging studies such as echocardiography. Treatment options may include medications to prevent blood clots or, in some cases, a procedure to close the PFO.
The prevalence of a patent foramen ovale in the general population varies, and it is estimated that about 25-30% of adults have a patent foramen ovale. The incidence may be higher in certain populations, such as individuals who have experienced a cryptogenic stroke or those with certain medical conditions.
The association between PFO and cryptogenic strokes has led to increased interest in studying the epidemiology of PFO in specific patient populations. Studies have suggested that PFO is more common in individuals who have experienced a cryptogenic stroke compared to the general population.
The prevalence of PFO among individuals with cryptogenic stroke varies, with estimates ranging from about 40-50% or higher in some studies. Some studies suggest that the prevalence of PFO may decrease with advancing age. The prevalence of PFO does not seem to differ significantly between males and females.
The patent foramen ovale is a flap-like opening situated between the primum at the fossa ovalis and atrial septum secundum. During fetal development, it functions as a conduit for blood to access the systemic circulation. Following birth, as pulmonary circulation intensifies, the functional PFO gradually closes. Anatomical closure typically occurs around 12 months of age.
PFO is primarily associated with an elevated risk of stroke resulting from a paradoxical embolism. Larger defects and the presence of interatrial aneurysms augment the risk of cryptogenic stroke in individuals with PFO. This heightened risk may be attributed to an increased formation of in situ thrombus in the aneurysmal tissue or the tendency of PFOs associated with an interatrial septal aneurysm to be larger.
Although paradoxical embolism through a PFO has been reported in previous studies, its precise magnitude as a risk factor for stroke remains undefined. This uncertainty stems from the infrequent detection of deep venous thrombosis in such patients.
Notably, a study revealed a higher incidence of pelvic vein thrombi in young patients with cryptogenic stroke compared to those with a known cause of stroke. This observation implies a potential source of venous thrombi, especially when an initial identification of a venous thromboembolism source is lacking.
The foramen ovale constitutes a tunnel-like passage between the superimposed septum secundum and septum primum. Approximately 75% of infants witness its closure upon the fusion of these septal structures. During fetal development, the foramen ovale plays a crucial role in facilitating blood flow across the atrial septum.
Oxygenated blood, originating from the placenta, returns to the inferior vena cava, traverses the foramen ovale, and is directed into the systemic circulation.
Genetic Factors: There may be a genetic predisposition to the persistence of the foramen ovale. Family history could play a role in the likelihood of having a patent foramen ovale.
Environmental Factors: Some environmental factors during fetal development might influence the closure of the foramen ovale. Exposure to certain substances or conditions could potentially contribute to the persistence of the opening.
Medical Conditions: Certain medical conditions or abnormalities in heart development may increase the likelihood of having a patent foramen ovale. For example, individuals with atrial septal defects may have a higher incidence of PFO.
In neonates and children, the prognosis for patent foramen ovale is highly favorable, with spontaneous closure occurring in the majority of cases. In instances where surgical closure becomes necessary in children and adults due to the risk of thromboembolism, the prognosis is generally positive, and surgical outcomes are well-documented. While percutaneous closure presents a promising alternative, it is important to note that complications are not uncommon in this approach.
PFO is often present at birth and is a normal part of fetal circulation. It should begin closing shortly after birth, with complete closure typically occurring by around 12 months of age. Many individuals remain asymptomatic throughout their lives. The presence of a PFO may be incidental and discovered during diagnostic testing for other health concerns.
Some individuals may experience migraine headaches, particularly migraine with aura. Symptoms can include severe headaches, visual disturbances, and sensitivity to light and sound. The onset of symptoms related to a cryptogenic stroke can vary, and individuals may experience a sudden or gradual onset of symptoms.
Migraine headaches associated with PFO may have variable onset and duration, with individuals experiencing episodic or chronic patterns. Some individuals may have a one-time event, while others may experience recurrent symptoms.
The physical examination typically reveals no notable findings. A faint systolic murmur, attributed to turbulence in the flow across the foramen, may be detectable upon auscultation.
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
In neonates and the pediatric demographic, the management and follow-up of patent foramen ovale are generally not required. PFO plays a crucial role in certain congenital heart conditions where blood shunting at the atrial level is essential.
In the adult population, the need for PFO treatment primarily arises in individuals experiencing cryptogenic strokes. Various approaches have been proposed for addressing this issue.
Several studies and trials have demonstrated that the percutaneous closure of patent foramen ovale using a device is more effective than medical therapy in reducing the risk of recurrence in patients under the age of 60. The Cardioseal Septal occlusion system and the Amplatzer PFO occluder have received FDA approval for percutaneous closure. The procedure is conducted with fluoroscopic guidance and necessitates hospital admission.
In cases where the PFO measures larger than 25 mm, fails to close through percutaneous methods, or exhibits an inadequate rim at the edge, making percutaneous closure challenging, a surgical approach is considered. Surgical closure ensures complete closure and eliminates the need for long-term anticoagulation. However, this approach requires open-heart surgery and entails the usual associated procedural risks.
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