Patent foramen ovale pathophysiology

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Patent Foramen Ovale Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [3]

Overview

A patent foramen ovale or PFO is not considered an atrial septal defect because there is not a permanent hole or defect in interatrial septum. Instead there is a flap-like structure that periodically opens which allows blood to shunt between the two atria. As a result, it is also sometimes called as a probe patent (PFO). This flap-like structure functions like a one-way valve mechanism that only opens to allow blood to flow from the right atrium to the left atrium during times where there is an increase flow or pressure in the right atrium. Elevation of pressure in the pulmonary circulatory system (i.e.: pulmonary hypertension due to various causes, or transiently during a cough or valsalva maneuver) can cause the foramen ovale to open. Because of this one-way valve like mechanism and the dynamic nature of the right to left shunting, a patient is often asked to perform a Valsalva maneuver during a echocardiographic bubble study to facilitate transit of bubbles from the right atrium to the left atrium.

Embryology

During gestation, the presence of a patent foramen ovale is neccessary for life as it allows for right-to-left shunting so that oxygenated blood can flow to the left side of the heart.

References