Patent foramen ovale natural history, complications and prognosis
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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]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]
Overview
The presence of a patent foramen ovale has been linked to decompression sickness, paradoxical embolism and migraine. There is a debate within the neurology and cardiology communities about the role of a patent foramen ovale in cryptogenic stroke. The prognosis of uncomplicated patent foramen ovale is generally good.
Natural History, Complications, and Prognosis
Natural History
- In majority of people, the foramen ovale closes later in infancy but anatomic closure is incomplete in about 25% of the population.[1]
- The size of a patent foramen ovale can range from 1 to 19mm. It is commonly larger in older adults.[1]
- On the left atrial side, the opening tends to be crescentric in shape.[1]
Complications
- Common complications of patent foramen ovale include:[2][3][4][5][6]
- Paradoxical embolism: This is from a venous thrombi leading to cerebral or peripheral stroke. The risk of a stroke is enhanced by the presence of some coexisting factors such as atrial septal defect, size of the patent foramen ovale, degree of the shunt, deep vein thrombosis, shunt at rest, and prothrombotic states.
- Hypoxemia
- Severe decompression sickness (due to paradoxical gas embolism) in divers.
Prognosis
- Overall, the prognosis of patients with patent foramen ovale is good and asymptomatic patients do not require treatment.
- The prognosis is excellent for those who undergo closure.
- Patients with patent foramen ovale may develop cryptogenic stroke due to paradoxical embolism.
References
- ↑ 1.0 1.1 1.2 Kutty, Shelby; Sengupta, Partho P.; Khandheria, Bijoy K. (2012). "Patent Foramen Ovale". Journal of the American College of Cardiology. 59 (19): 1665–1671. doi:10.1016/j.jacc.2011.09.085. ISSN 0735-1097.
- ↑ Homma S, Messé SR, Rundek T, Sun YP, Franke J, Davidson K; et al. (2016). "Patent foramen ovale". Nat Rev Dis Primers. 2: 15086. doi:10.1038/nrdp.2015.86. PMID 27188965.
- ↑ Tobis JM, Narasimha D, Abudayyeh I (2017). "Patent Foramen Ovale Closure for Hypoxemia". Interv Cardiol Clin. 6 (4): 547–554. doi:10.1016/j.iccl.2017.05.003. PMID 28886845.
- ↑ Kolte, Dhaval; Inglessis, Ignacio; Elmariah, Sammy (2020). "Peripheral Embolism and PFO": 109–113. doi:10.1016/B978-0-12-816966-7.00009-9.
- ↑ Pinto FJ (2005). "When and how to diagnose patent foramen ovale". Heart. 91 (4): 438–40. doi:10.1136/hrt.2004.052233. PMC 1768819. PMID 15772190.
- ↑ Falanga G, Carerj S, Oreto G, Khandheria BK, Zito C (2014). "How to Understand Patent Foramen Ovale Clinical Significance: Part I." J Cardiovasc Echogr. 24 (4): 114–121. doi:10.4103/2211-4122.147202. PMC 5353567. PMID 28465918.