Patent foramen ovale

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [[2]]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [[4]]

Overview

During fetal development, the septal wall may fail to fuse causing an atrial septal defect to arise. A patent foramen ovale atrial septal defect is one such type of malformation arising from the irregular development of the foramen ovale.

Patent Foramen Ovale

• A patent foramen ovale (PAY-tent for-amen oh-VALL-ee) (PFO) is a small channel that has little hemodynamic consequence.
• Clinically it is linked to decompression sickness, paradoxical embolism and migraine. In addition, there is some data to suggest that PFOs may be involved in the pathogenesis of some migraine headaches. Several clinical trials are currently underway to investigate the role of PFO in these clinical situations. There is a debate within the neurology and cardiology communities about the role of a PFO in cryptogenic (i.e. of unknown cause) neurologic events, e.g. strokes and transient ischemia attacks (TIAs) without any other potential cause. On echocardiography, there may not be any shunting of blood noted except when the patient coughs.
• Approximately 1 in every three normal adult hearts have a patent foramen ovale.
• In this case, elevation of pressure in the pulmonary circulatory system (ie: pulmonary hypertension due to various causes, or transiently during a cough) can cause the foramen ovale to remain open. The patent foramen ovale can be of two types –
  • Completely covered but not completely sealed so that the foramen can be opened with reversal of shunt. This is also sometimes called as a probe patent or patent foramen ovale (PFO)
  • An open communication exists between right and left atrium persists which is then called an atrial septal defect (ASD).A PFO is not considered an ASD because no septal tissue is missing.

A PFO may occur as a familial trait.