II. Epidemiology
- Prevalence: 25%
III. Pathophysiology
- Incomplete closure of the atrial septum
- Septum primum and secundum fail to fuse
- Creates a flap opening in the atrial septal wall
- Persistent path between atrial chamber into adulthood
IV. Associated findings
- Patent Foramen Ovale Aneurysm (uncommon)
- Fenestrations
V. Management
- No management needed for most patients
- Indications for Patent Foramen Surgical Closure in Cryptogenic Stroke (Idiopathic CVA)
- Large PFO
- PFO associated with atrial septal aneurysm
- Recurrent cryptogenic stroke
- Mas (2017) N Engl J Med 377:1011-21 [PubMed]
- Saver (2017) N Engl J Med 377:1022-32 [PubMed]
- Søndergaard (2017) N Engl J Med 377:1033-42 [PubMed]
- Other management in cryptogenic stroke (e.g. single CVA with small PFO)
- See Prevention of Ischemic Stroke
- Antiplatelet agents
VI. Complications
- Consider as benign incidental finding in most patients
- Cryptogenic Stroke (CVA without definitive cause)
- Prospective trials do not show increased CVA risk
- However, large PFO or PFO associated with atrial septal aneurysm may
VII. References
- Nelson (2007) MP Primary Care Medicine, Lecture