Patent foramen ovale
Patent foramen ovale is a persistent flap-like interatrial communication present in about a quarter of adults, usually benign. Its clinical importance is as a conduit for paradoxical embolism causing cryptogenic stroke; in selected younger patients with cryptogenic stroke, device closure plus antiplatelet therapy reduces recurrence.
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What this article covers
- Overview
Definition: patent foramen ovale (PFO) is persistence of the fetal flap-valve communication between the atria that normally seals after birth, leaving a potential right-to-left conduit.
- Epidemiology
Present in roughly a quarter of adults. Usually an incidental, benign finding.
- Risk factors
Congenital persistence (present from birth in a large minority).
- Pathophysiology
Flap-valve communication: the overlapping septum primum and secundum normally seal but can separate when right atrial pressure rises.
- Clinical features
Usually asymptomatic and incidental. Cryptogenic ischemic stroke or transient ischemic attack as the key presentation.
- Differential diagnosis
Atrial septal defect: a true structural defect with a significant shunt (Atrial septal defect).
- Diagnosis
Establish with echocardiography and an agitated-saline bubble study demonstrating right-to-left shunting: the diagnostic basis is echocardiography (transthoracic or transesophageal) with an…
- Management
First-line, no treatment for an incidental PFO: most PFOs are benign and require only reassurance.
- Complications
Recurrent paradoxical embolic stroke. Procedural complications of closure (atrial arrhythmia, device issues).
- Prognosis
Benign for the incidental majority. Closure reduces recurrent stroke in appropriately selected patients.
- Prevention
Standard stroke prevention and risk-factor control (blood pressure below 130/80 mmHg).
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