patent foramen ovale (PFO)

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Etiology

Epidemiology

  • occurs in 25-30% of population[1]

Pathology

Clinical manifestations

  • most patients are asymptomatic

Diagnostic procedures

Radiology

Complications

Management

Notes

More general terms

Additional terms

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018, 2022
  2. 2.0 2.1 Journal Watch 22(2):11, 2002 Mas JL et al Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 345:1740, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11742048
  3. 3.0 3.1 3.2 Journal Watch 22(16):126-27, 2002 Homma S et al, Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke study Circulation 105:2565, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12045168
    Halperin JL & Fuster V, Patent foramen ovale and recurrent stroke: another paradoxical twist. Circulation 105:2580, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12045158
  4. 4.0 4.1 Handke M et al, Patient foramen ovale and cryptogenic stroke in older patients. N Engl J Med 2007, 357:2262 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18046029
  5. 5.0 5.1 Journal Watch, Massachusetts Medical Society, March 16, 2012 Furlan AJ et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 2012 Mar 15; 366:991. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22417252
  6. A.D.A.M. Medical Encyclopedia Patent foramen ovale http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002102/
  7. Shan SN eMedicine (Medscape): Patent foramen ovale http://emedicine.medscape.com/article/156863-overview
  8. 8.0 8.1 Meier B et al. for the PC Trial investigators. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 2013 Mar 21; 368:1083 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23514285 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1211716
    Carroll JD et al. for the RESPECT investigators. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med 2013 Mar 21; 368:1092 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23514286 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1301440
  9. Meier B, Lock JE. Contemporary management of patent foramen ovale. Circulation. 2003 Jan 7;107(1):5-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12515733
  10. Chen L, Luo S, Yan L, Zhao W A systematic review of closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and cryptogenic stroke or transient ischemic attack. J Neurol Sci. 2014 Feb 15;337(1-2):3-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24300230
  11. DeSimone CV, Friedman PA, Noheria A et al Stroke or transient ischemic attack in patients with transvenous pacemaker or defibrillator and echocardiographically detected patent foramen ovale. Circulation. 2013 Sep 24;128(13):1433-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23946264
  12. 12.0 12.1 Messe SR et al. Practice advisory: Recurrent stroke with patent foramen ovale (update of practice parameter). Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2016 Jul 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27466464
  13. 13.0 13.1 Phend C PFO Closure for Cryptogenic Stroke Prevents Recurrences - First overall stroke reduction with closure reported in two trials. MedPage Today. May 16, 2017 https://www.medpagetoday.com/Cardiology/Strokes/65348
  14. 14.0 14.1 14.2 14.3 Mas JL et al Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. N Engl J Med 2017; 377:1011-1021. September 14, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28902593 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1705915
    Saver JL et al Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med 2017; 377:1022-1032. September 14, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28902590 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1610057
    Sondergaard L et al Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med 2017; 377:1033-1042. September 14, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28902580 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1707404
    Farb A et al Patent Foramen Ovale after Cryptogenic Stroke - Assessing the Evidence for Closure. N Engl J Med 2017; 377:1006-1009. September 14, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28902595 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMp1700218
    Ropper AH. Tipping point for patent foramen ovale closure. N Engl J Med 2017 Sep 14; 377:1093 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28902592 <Internet> http://www.nejm.org/doi/10.1056/NEJMe1709637
  15. 15.0 15.1 De Rosa S, Sievert H, Sabatino J et al Percutaneous Closure Versus Medical Treatment in Stroke Patients With Patent Foramen Ovale: A Systematic Review and Meta-analysis. Ann Intern Med. 2018. Jan 9. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29310133 <Internet> http://annals.org/aim/article-abstract/2668217/percutaneous-closure-versus-medical-treatment-stroke-patients-patent-foramen-ovale
    Shah R, Nayyar M, Jovin IS Device Closure Versus Medical Therapy Alone for Patent Foramen Ovale in Patients With Cryptogenic Stroke: A Systematic Review and Meta-analysis. Ann Intern Med. 2018. Jan 9. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29310136 <Internet> http://annals.org/aim/article-abstract/2668216/device-closure-versus-medical-therapy-alone-patent-foramen-ovale-patients
  16. 16.0 16.1 Ng PY, Ng AKy, MSubramaniam B et al Association of Preoperatively Diagnosed Patent Foramen Ovale With Perioperative Ischemic Stroke. JAMA. 2018;319(5):452-462 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29411032 https://jamanetwork.com/journals/jama/fullarticle/2671466
    Kasner SE, Messe SR Is Patent Foramen Ovale a Risk Factor for Perioperative Stroke? JAMA. 2018;319(5):446-447. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29411017 https://jamanetwork.com/journals/jama/article-abstract/2671449
  17. 17.0 17.1 Elgendy AV, Saver JL, Amin Z et al Proposal for Updated Nomenclature and Classification of Potential Causative Mechanism in Patent Foramen Ovale-Associated Stroke. JAMA Neurol. Published online April 13, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32282016 https://jamanetwork.com/journals/jamaneurology/fullarticle/2763602
  18. 18.0 18.1 18.2 18.3 Messe SR et al. Practice advisory update summary: Patent foramen ovale and secondary stroke prevention: Report of the Guideline Subcommittee of the American Academy of Neurology. Neurology 2020 May 19; 94:876. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32350058 https://n.neurology.org/content/94/20/876