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Patent Foramen Ovale

Title               

Ñ    Patent Foramen Ovale (PFO)

Definition

Ñ    Anatomical communication

Ñ    Between the right and left atria

Ñ    With potential for right to left shunt

Aetiology

Ñ    Congenital

Pathogenesis

Ñ    After birth, increase in left atrial pressure pushes the septum secundum against the septum primum and closes the foramen ovale

Ñ    Fusion of the septa occurs with anatomical closure:

Within 1 year

Ñ    In PFO anatomical closure does not occur

Ñ    Increase in right atrial pressure causes paradoxical flow and paradoxical embolism

Clinical Features

History

Ñ    Mainly asymptomatic

CNS

Ñ    Migraine

Ñ    Stroke

Ñ    Transient ischaemic attack (TIA)

Examination

CVS

Ñ    No abnormal findings

Complications

Ñ    Completed or transient neurological deficit

Investigations

Imaging

Ultrasound

Ñ    Bubble echocardiography:

Inject agitated saline into antecubital vein; microbubbles appearing in left atrium is a positive study

Valsalva manoeuvre facilitates shunting

Ñ    Transoesophageal echo:

More sensitive

Management

Cure

Surgery

Ñ    Surgical closure

Ñ    Catheter based closure

Prevention

Drugs

Ñ    Aspirin:

Prevent stroke

Ñ    Warfarin:

Prevent stroke

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