Patent foramen ovale

Introduction
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By Catalina Ionita MD

Patent foramen ovale is widely prevalent in the normal population. Although paradoxical embolism through a patent foramen ovale has been recognized as a pathological entity since 1877, in 1988 Lechat and colleagues first sought to demonstrate an association with strokes and the presence of a patent foramen ovale. Since then, numerous retrospective, prospective, population-based, and therapeutic studies have sought to validate this association and also to demonstrate the association with other disease states such as migraine. The data from these studies are frequently conflicting, leading many authorities to even question such an association. Dr. Ionita of the Department of Neurosciences at Catholic Health System of Buffalo provides an update on this controversial issue by revealing the results of the RESPECT study presented at the International Stroke Conference. The efficacy analyses showed a 46.6% to 72.7% risk reduction of stroke in favor of the AMPLATZER™ device in combination with medical treatment versus medical treatment alone. Also, the safety of transcutaneous patent foramen ovale closure is supported by the recently published Italian patent foramen ovale closure survey, which reported a low rate of recurrent neurologic events in spite of a significant rate of persistent right-to-left shunt after closure.

Key Points

  • Although highly prevalent and asymptomatic in the general population, patent foramen ovale is associated with 2 major neurologic conditions: stroke and migraine headache.
  • A direct causality and the pathogenic implication of patent foramen ovale in stroke and migraine occurrence remain to be established.
  • The best strategy for stroke prevention in patients with patent foramen ovale is controversial.
  • The benefit of transcutaneous patent foramen ovale closure for stroke prevention and migraine improvement remains under investigation.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors