Patent foramen ovale
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A patent foramen ovale (PFO) is a type ofatrial septal defect in which there is channel-like communication between the atria through an unfused fossa ovalisovale..
Gross anatomy
The foramen ovale in the interatrial septum normally normally develops into the fossa ovalis when the the flaps of the atrial septa primum and secundum normally fuse during during development. The foramen foramen ovale remains patent patent if there is incompletely fusion. This variant occurs occurs in 25-33% of adults1,2. The prevalence may decrease with advancing age.
Patent foramen ovales/foramina ovalia are subdivided into:
- probe-patent foramen ovale
- patent foramen ovale
A "probe patent" foramen ovale is defined as a defect in the fossa ovalis that would be revealed with instrument probing.
Pathology
A patent foramen ovale has been associated withparadoxical embolism and ischemic stroke because of the potential for a venous thromboembolism to pass from the right atrium to the systemic circulation, bypassing the lungs.
PFOs are small enough to be haemodynamically insignificant.
Radiographic features
Transesophageal echocardiography
- may be detected on a "bubble study" (IV injection of agitated saline); the contrast material appears in the left atrium before the normal time
Cardiac CT
- abnormal communication of contrast material between the atria
throughthrough a channel-like tunnel in the interatrial septum - a channel-like tunnel alone is a normal variant of the fossa ovalis, and
isis not diagnostic
Contrast-enhanced cardiac MRI
- not
aa first-line study, but may bediagnoseddiagnosed by visualassessmentassessment orcomputationcomputation of signal–timecurvescurves in the pulmonary vein and the left atrium3
A patent foramen ovale can be differentiated from an atrial septal defect because a a PFO takes a tunneled intraseptal course, or with the presence of a flap valve on the left atrial side of the foramen2.
Treatment and prognosis
Closure devices, both surgically open and percutaneous, have been developed and are currently implemented implemented in some centers for PFO.
-<p>A <strong>patent foramen ovale</strong> (<strong>PFO</strong>) is a type of <a href="/articles/atrial-septal-defect-2">atrial septal defect</a> in which there is channel-like communication between the atria through an unfused <a href="/articles/fossa-ovalis">fossa ovalis</a>.</p><h4>Gross anatomy</h4><p>The foramen ovale in the interatrial septum normally develops into the fossa ovalis when the flaps of the atrial septa primum and secundum normally fuse during development. The foramen ovale remains patent if there is incompletely fusion. This variant occurs in 25-33% of adults <sup>1,2</sup>. The prevalence may decrease with advancing age.</p><p>Patent foramen ovales/foramina ovalia are subdivided into:</p><ul>- +<p>A <strong>patent foramen ovale</strong> (<strong>PFO</strong>) is a type of <a href="/articles/atrial-septal-defect-2">atrial septal defect</a> in which there is channel-like communication between the atria through an unfused <a title="fossa ovale" href="/articles/fossa-ovale">fossa <font color="#0782c1"><u>ovale.</u></font></a></p><h4>Gross anatomy</h4><p>The <a title="Foramen ovale (cardiac)" href="/articles/foramen-ovale-cardiac-1">foramen ovale</a> in the interatrial septum normally develops into the fossa ovalis when the flaps of the atrial septa primum and secundum normally fuse during development. The foramen ovale remains patent if there is incompletely fusion. This variant occurs in 25-33% of adults <sup>1,2</sup>. The prevalence may decrease with advancing age.</p><p>Patent foramen ovales/foramina ovalia are subdivided into:</p><ul>
-</ul><p>A "probe patent" foramen ovale is defined as a defect in the fossa ovalis that would be revealed with instrument probing.</p><h4>Pathology</h4><p>A patent foramen ovale has been associated with <a href="/articles/paradoxical-embolism">paradoxical embolism</a> and <a href="/articles/ischaemic-stroke">ischemic stroke</a> because of the potential for a <a href="/articles/venous-thromboembolism">venous thromboembolism</a> to pass from the right atrium to the systemic circulation, bypassing the lungs.</p><p>PFOs are small enough to be haemodynamically insignificant.</p><h4>Radiographic features</h4><h5>Transesophageal echocardiography</h5><ul><li>may be detected on a "bubble study" (IV injection of agitated saline); the contrast material appears in the left atrium before the normal time</li></ul><h5>Cardiac CT</h5><ul>-<li>abnormal communication of contrast material between the atria through a channel-like tunnel in the interatrial septum</li>-<li>a channel-like tunnel alone is a normal variant of the fossa ovalis, and is not diagnostic</li>-</ul><h5>Contrast-enhanced cardiac MRI</h5><ul><li>not a first-line study, but may be diagnosed by visual assessment or computation of signal–time curves in the pulmonary vein and the left atrium <sup>3</sup>-</li></ul><p>A patent foramen ovale can be differentiated from an atrial septal defect because a PFO takes a tunneled intraseptal course, or with the presence of a flap valve on the left atrial side of the foramen <sup>2</sup>. </p><h4>Treatment and prognosis</h4><p>Closure devices, both surgically open and percutaneous, have been developed and are currently implemented in some centers for PFO.</p>- +</ul><p>A "probe patent" foramen ovale is defined as a defect in the fossa ovalis that would be revealed with instrument probing.</p><h4>Pathology</h4><p>A patent foramen ovale has been associated with <a href="/articles/paradoxical-embolism">paradoxical embolism</a> and <a href="/articles/ischaemic-stroke">ischemic stroke</a> because of the potential for a <a href="/articles/venous-thromboembolism">venous thromboembolism</a> to pass from the right atrium to the systemic circulation, bypassing the lungs.</p><p>PFOs are small enough to be haemodynamically insignificant.</p><h4>Radiographic features</h4><h5>Transesophageal echocardiography</h5><ul><li>may be detected on a "bubble study" (IV injection of agitated saline); the contrast material appears in the left atrium before the normal time</li></ul><h5>Cardiac CT</h5><ul>
- +<li>abnormal communication of contrast material between the atria through a channel-like tunnel in the interatrial septum</li>
- +<li>a channel-like tunnel alone is a normal variant of the fossa ovalis, and is not diagnostic</li>
- +</ul><h5>Contrast-enhanced cardiac MRI</h5><ul><li>not a first-line study, but may be diagnosed by visual assessment or computation of signal–time curves in the pulmonary vein and the left atrium <sup>3</sup>
- +</li></ul><p>A patent foramen ovale can be differentiated from an atrial septal defect because a PFO takes a tunneled intraseptal course, or with the presence of a flap valve on the left atrial side of the foramen <sup>2</sup>. </p><h4>Treatment and prognosis</h4><p>Closure devices, both surgically open and percutaneous, have been developed and are currently implemented in some centers for PFO.</p>
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