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]]
Synonyms and Keywords: patent foramen, PFO, probe patent PFO
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 the septum secundum.
Epidemiology and Demographics
Approximately 1 in every three normal adult hearts have a patent foramen ovale.
Risk Factors
Genetics may play a role in the development of a patent foramen ovale insofar as the disorder has been found to occur with an increased frequency in families.
Pathophysiology
If there are elevated right sided pressures, shunting of blood from the right atrium to the left atrium can occur. The patent foramen ovale is completely covered but not completely sealed. As a result, it is also sometimes called as a probe patent (PFO) (as the foramen can be opened with reversal of shunt).
Natural History, Complications, and Prognosis
Clinically it is linked to decompression sickness, paradoxical embolism and migraine. There is a debate within the neurology and cardiology communities about the role of a PFO in cryptogenic stroke 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.