Patent foramen ovale overview: Difference between revisions
No edit summary |
No edit summary |
||
| Line 48: | Line 48: | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Overview complete]] | [[Category:Overview complete]] | ||
[[Category:Up | [[Category:Up-To-Date]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 20:03, 8 September 2011
|
Patent Foramen Ovale Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Patent foramen ovale overview On the Web |
|
American Roentgen Ray Society Images of Patent foramen ovale overview |
|
Risk calculators and risk factors for Patent foramen ovale overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]
Overview
A patent foramen ovale is a communication between the right and left atrium. Despite the communication between the two atrium, it is not considered an atrial septal defect as the septal tissue is not missing.
Epidemiology and Demographics
The incidence of Patent foramen ovale has been found to be approximately 30% in different studies.[1]. The incidence decreases with increasing age, but the size increases with age. There is no difference in the incidence associated with gender.
Natural History, Complications and Prognosis
Patent foramen ovale commonly produces no symptoms and may be an incidental finding on echocardiography done for other purposes. In some individuals it might present with complications like stroke, migraine, decompression sickness and platypnoea orthodeoxia syndrome.
Causes
The exact causes for patent foramen ovale is still not clear. However, it has been found to occur with increased frequencies in families and might have some genetic component to it.
Diagnosis
Symptoms and sign
Most individuals with patent foramen ovale are asymptomatic although some may present with rare symptoms like migraines, stroke, decompression illness and platypnoea orthodeoxia syndrome.
Echocardiography
Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and transcranial Doppler (TCD) are the commonly used diagnostic tools for patent foramen ovale[2]. Transesophageal echocardiography is more sensitive in visualizing the interatrial septum, than transthoracic echocardiography and is the imaging modality of choice [3], [4]. Transthoracic echocardiography (TTE)with contrast at rest, with cough, and after valsalva maneuver is generally considered the most definitive diagnostic test for PFO.
Treatment
Medical therapy
The medical therapy for the patients with patent foramen ovale is controversial. Medical therapy with antiplatelet therapy (aspirin) or anticoagulant therapy (warfarin) could be considered in patients with recurrent strokes after index episode of cryptogenic stroke and unresponsive migraines. However, the relative effectiveness of aspirin or warfarin in these patients has not been proved.
Percutaneous closure
There is lack of consensus regarding the effectiveness of percutaneous closure of patent foramen ovale. There are insufficient evidences to recommend device closure for a first stroke. PFO closure may be considered for recurrent cryptogenic stroke and high-risk patent foramen ovale (PFO) (atrial septal aneurysm)[5].
References
- ↑ Meissner I, Whisnant JP, Khandheria BK, Spittell PC, O'Fallon WM, Pascoe RD; et al. (1999). "Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC study. Stroke Prevention: Assessment of Risk in a Community". Mayo Clin Proc. 74 (9): 862–9. PMID 10488786.
- ↑ Sastry S, Daly K, Chengodu T, McCollum C (2007). "Is transcranial Doppler for the detection of venous-to-arterial circulation shunts reproducible?". Cerebrovasc Dis. 23 (5–6): 424–9. doi:10.1159/000101466. PMID 17406112.
- ↑ Thanigaraj S, Valika A, Zajarias A, Lasala JM, Perez JE (2005). "Comparison of transthoracic versus transesophageal echocardiography for detection of right-to-left atrial shunting using agitated saline contrast". Am J Cardiol. 96 (7): 1007–10. doi:10.1016/j.amjcard.2005.05.061. PMID 16188533.
- ↑ Van Camp G, Franken P, Melis P, Cosyns B, Schoors D, Vanoverschelde JL (2000). "Comparison of transthoracic echocardiography with second harmonic imaging with transesophageal echocardiography in the detection of right to left shunts". Am J Cardiol. 86 (11): 1284–7, A9. PMID 11090813.
- ↑ European Stroke Organisation (ESO) Executive Committee. ESO Writing Committee (2008). "Guidelines for management of ischaemic stroke and transient ischaemic attack 2008". Cerebrovasc Dis. 25 (5): 457–507. doi:10.1159/000131083. PMID 18477843.