Patent Foramen Ovale

Aka: Patent Foramen Ovale, PFO

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II. Epidemiology

  1. Prevalence: 25%

III. Pathophysiology

  1. Incomplete closure of the atrial septum
    1. Septum primum and secundum fail to fuse
    2. Creates a flap opening in the atrial septal wall
  2. Persistent path between atrial chamber into adulthood

IV. Associated findings

  1. Patent Foramen Ovale Aneurysm (uncommon)
  2. Fenestrations

V. Management

  1. No management needed for most patients
  2. Indications for Patent Foramen Surgical Closure in Cryptogenic Stroke (Idiopathic CVA)
    1. Large PFO
    2. PFO associated with atrial septal aneurysm
    3. Recurrent cryptogenic stroke
    4. Mas (2017) N Engl J Med 377:1011-21 [PubMed]
    5. Saver (2017) N Engl J Med 377:1022-32 [PubMed]
    6. Søndergaard (2017) N Engl J Med 377:1033-42 [PubMed]
  3. Other management in cryptogenic stroke (e.g. single CVA with small PFO)
    1. See Prevention of Ischemic Stroke
    2. Antiplatelet agents

VI. Complications

  1. Consider as benign incidental finding in most patients
  2. Cryptogenic Stroke (CVA without definitive cause)
    1. Prospective trials do not show increased CVA risk
    2. However, large PFO or PFO associated with atrial septal aneurysm may

VII. References

  1. Nelson (2007) MP Primary Care Medicine, Lecture

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