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Patent foramen ovale

Last reviewed: 15 Set 2025
Last updated: 08 Fev 2022

Summary

Definition

History and exam

Key diagnostic factors

  • atrial septal aneurysm
  • congenital heart conditions
  • cerebrovascular accident (CVA) at ages <60 years
  • abnormal cardiac examination
  • deep vein thrombosis
Full details

Other diagnostic factors

  • decompression symptoms related to diving
  • cold sensation in limb
  • limb pain
  • shortness of breath while upright in platypnoea-orthodeoxia syndrome
Full details

Risk factors

  • atrial septal aneurysm
  • congenital heart conditions
  • family history of migraine
  • migraine
  • family history of PFO
  • obstructive sleep apnoea
Full details

Diagnostic investigations

1st investigations to order

  • transthoracic echo with colour Doppler and contrast injection
  • trans-oesophageal echo with colour Doppler and contrast injection
Full details

Investigations to consider

  • intracardiac echo
  • ultrasound lower extremity
  • MRI lower extremity
  • tilt-table trans-oesophageal echo
Full details

Emerging tests

  • transcranial Doppler

Treatment algorithm

ONGOING

asymptomatic with low risk of thrombotic event (not in high-risk occupation)

asymptomatic with high risk of thrombotic event (not in high-risk occupation)

cryptogenic stroke

high-risk occupation

Contributors

Authors

Kul Aggarwal, MD, MRCP, FACC
Kul Aggarwal

Professor of Clinical Medicine

University of Missouri

Columbia

MO

Disclosures

KA is the author of a reference cited in this topic.

Poorna R Karuparthi, MD, FACC

Clinical Assistant Professor

University of Missouri Hospital

Division of Cardiology

University of Missouri

Columbia

MO

Disclosures

PRK declares that he has no competing interests.

Acknowledgements

Professor Kul Aggarwal and Poorna R Karuparthi would like to gratefully acknowledge Dr Vibhuti Singh, a previous contributor to this topic.

Disclosures

VS declares that he has no competing interests.

Peer reviewers

Navin Nanda, MD

Professor of Medicine

Director Heart Station and Echocardiography Laboratories

University of Alabama at Birmingham

Birmingham

AL

Disclosures

NN declares that he has no competing interests.

Andrew Turley, MB ChB

Cardiology Specialist Registrar

The James Cook University Hospital

Middlesbrough

UK

Declarações

AT declares that he has no competing interests.

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Key articles

Silvestry FE, Cohen MS, Armsby LB, et al. Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale: from the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr. 2015 Aug;28(8):910-58.Full text  Abstract

Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013 Mar 21;368(12):1083-91. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Patent foramen ovale images
  • Differentials

    • Arteriovenous malformation (AVM) in the lung
    More Differentials
  • Guidelines

    • 2020 ESC guidelines for the management of adult congenital heart disease
    • 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack
    More Guidelines
  • Patient information

    Migraine

    More Patient information
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