Patent foramen ovale natural history, complications and prognosis
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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
The presence of a patent foramen ovale has been linked to decompression sickness, paradoxical embolism and migraine. There is a debate within the neurology and cardiology communities about the role of a patent foramen ovale in cryptogenic stroke. The prognosis of uncomplicated patent foramen ovale is generally good.
Natural History, Complications, and Prognosis
Natural History
Complications
- Common complications of patent foramen ovale include:[1][2][3][4]
- Paradoxical embolism: This is from a venous thrombi leading to cerebral or peripheral stroke. The risk of a stroke is enhanced by the presence of some coexisting factors such as atrial septal defect, size of the patent foramen ovale, degree of the shunt, deep vein thrombosis, shunt at rest, and prothrombotic states.
- Hypoxemia
- Severe decompression sickness (due to paradoxical gas embolism)
Prognosis
- The prognosis of patent foramen ovale depends on the size of defect, amount of shunting and presence of any associated defects.
- Overall, the prognosis of patients with patent foramen ovale is good.
- Some infants presenting with cyanosis due to right-to-left shunting, might have complete resolution as they grow up (due to decrease in pulmonary vascular resistance).
- Patent foramen ovale associated with other congenital heart defects like Ebstein's anomaly might continue to have problems due to right-to-left shunting.
- Also, some patients with cryptogenic stroke might continue to have transient ischemic attacks and stroke due to continued right-to-left shunting.
- An incidentally discovered, asymptomatic patent foramen ovale, doesn't require any special treatment or follow-up.
References
- ↑ Homma S, Messé SR, Rundek T, Sun YP, Franke J, Davidson K; et al. (2016). "Patent foramen ovale". Nat Rev Dis Primers. 2: 15086. doi:10.1038/nrdp.2015.86. PMID 27188965.
- ↑ Tobis JM, Narasimha D, Abudayyeh I (2017). "Patent Foramen Ovale Closure for Hypoxemia". Interv Cardiol Clin. 6 (4): 547–554. doi:10.1016/j.iccl.2017.05.003. PMID 28886845.
- ↑ Kolte, Dhaval; Inglessis, Ignacio; Elmariah, Sammy (2020). "Peripheral Embolism and PFO": 109–113. doi:10.1016/B978-0-12-816966-7.00009-9.
- ↑ Pinto FJ (2005). "When and how to diagnose patent foramen ovale". Heart. 91 (4): 438–40. doi:10.1136/hrt.2004.052233. PMC 1768819. PMID 15772190.