Patent foramen ovale

Patent foramen ovale (PFO) is a common finding, reported in approximately 10% of people undergoing contrast echo.

Usually asymptomatic but may be associated with cryptogenic stroke.

Atrial septal aneurysm is a risk factor for PFO, and when present in combination is associated with an increased risk of cerebrovascular accident (CVA).

Asymptomatic patients are generally observed without medical intervention.

In patients younger than 60 years with PFO and cryptogenic stroke, percutaneous PFO closure with antiplatelet therapy is recommended.

Multi-disciplinary approach in the evaluation of patients with cryptogenic stroke and shared decision making by involving patients are essential in identifying the best management option.

Routine closure of the PFO is not recommended in the presence of alternative mechanisms for CVA.

PFO is the persistent patency of a congenital opening or foramen ovale in the interatrial septum, which normally closes after birth. Notably, PFO is a potential cause of paradoxical embolism leading to CVA.