Patent Foramen Ovale

(PFO)

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Description

-  Failure of foramen ovale within atrial septum to fully seal post natally resulting in interatrial communication & possible right to left shunt

 

 

Features

-  Foramen ovale allows right to left shunting in utero

-  Incidence 25% +/-

-  Idiopathic

-  No increased risk of IE

-  Not currently viewed as a contraindication to scuba dive (risk of stroke)

-  Possible increased risk if PFO noted at rest on Echo but not if only demonstrated by Vasalva

 

Associated S/S

-  Typically asymptomatic

-  +/- migraines

 

Complications

-  Stroke (paradoxical cardioembolic)

-  More likely to be cause if unknown source & <55yrs old

-  High recurrence rate 3-4% per year

-  Atrial septal aneurysm

-  Increased risk of migraines (? improvement w closure)

-  Neurologic decompression sickness (scub divers)

 

Ix

-  Echo: TTE +/- TOE

-  +/- contrast (agitated saline)

 

Mx

-  Conservative unless other heart abnormalities or stroke (paradoxical cardioembolic)

-  Anticoagulation

-  Cardiac catheterization for percutaenous closure

-  Cardiac implant

-  Surgical closure

-  Open heart surgery under GA

-  If other methods of closure failed

-  PFO >25mm

 

 

 

References

 

Cleveland Clinic (incl Pic): Patent Foramen Ovale: my.clevelandclinic.org/heart/disorders/congenital/pfo.aspx

eMedicine: Patent Formaen Ovale: emedicine.medscape.com/article/156863-overview

Medscape: Diving Medicine: Review of PFO: www.medscape.com/viewarticle/710379_10