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
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.
Embryology
The presence of a patent foramen ovale is due to failure of fusion between the septum primum and septum secundum.
Epidemiology and Demographics
Approximately 1 in every three normal adult hearts have a patent foramen ovale.
Pathophysiology
In case of elevation of pressure in the right side of heart, shunting of blood from right atrium to left atrium can occur across it.
- The patent foramen ovale is completely covered but not completely sealed. Due to this, it is also sometimes called as a probe patent (PFO) (as the foramen can be opened with reversal of shunt).
- 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.
- Elevation of pressure in the pulmonary circulatory system (i.e.: pulmonary hypertension due to various causes, or transiently during a cough) can cause the foramen ovale to remain open.
- A patent foramen ovale has been found to occur with increased incidences in families.