Patent foramen ovale

Last reviewed: 16 Apr 2022
Last updated: 08 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • atrial septal aneurysm
  • congenital heart conditions
  • cerebrovascular accident (CVA) or transient ischemic attack at ages <60 years
  • abnormal cardiac examination
  • deep vein thrombosis
More key diagnostic factors

Other diagnostic factors

  • decompression symptoms related to diving
  • cold sensation in limb
  • limb pain
  • shortness of breath while upright in platypnea-orthodeoxia syndrome
Other diagnostic factors

Risk factors

  • atrial septal aneurysm
  • congenital heart conditions
  • family history of migraine
  • migraine
  • family history of PFO
  • obstructive sleep apnea
More risk factors

Diagnostic investigations

1st investigations to order

  • transthoracic echo with color Doppler and contrast injection
  • transesophageal echo with color Doppler and contrast injection
More 1st investigations to order

Investigations to consider

  • intracardiac echo
  • ultrasound lower extremity
  • MRI lower extremity
  • tilt-table transesophageal echo
More investigations to consider

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/transient ischemic attack

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

Disclosures

AT declares that he has no competing interests.

  • Patent foramen ovale images
  • Differentials

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

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

    Migraine

    More Patient leaflets
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