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| patent foramen ovale | |
|---|---|
| Name | Patent foramen ovale |
| Field | Cardiology |
| Symptoms | Stroke, transient ischemic attack, migraine |
| Complications | Cryptogenic stroke, decompression sickness, paradoxical embolism |
patent foramen ovale is a cardiac anatomical variant in which the foramen ovale fails to close after birth, creating a potential right-to-left atrial shunt that can permit embolic passage between venous and arterial circulations. It is implicated in a range of clinical scenarios from cryptogenic Stroke and Transient ischemic attack to decompression events among divers, and it has been the subject of interventional trials and guideline controversies involving cardiology and neurology societies.
The interatrial septum normally forms through coordinated development of the septum primum, septum secundum, and the ostium secundum during fetal life, processes described in classical embryology texts and taught at institutions like Harvard Medical School and Johns Hopkins University. The foramen ovale is a flap-like communication allowing right-to-left flow in the fetal circulation, directing oxygenated blood from the Inferior vena cava toward the left atrium and into the systemic circulation, a physiology emphasized in descriptions by researchers associated with Guy's Hospital and Mayo Clinic. Failure of fusion of the septum primum and septum secundum results in a patent foramen ovale, an entity examined in anatomical collections at the Royal College of Surgeons and in imaging cohorts from centers such as Cleveland Clinic and Mount Sinai Hospital.
Population studies, including autopsy series from the William Osler era and modern echocardiographic surveys at Framingham Heart Study and tertiary centers like Massachusetts General Hospital, report prevalence estimates of patent foramen ovale ranging widely, often cited near 25% of adults. Prevalence varies by age cohorts studied in registries associated with World Health Organization partner studies and by detection modality used at centers such as Karolinska Institute and University of Oxford. Risk factors associated with clinical events in the presence of patent foramen ovale have been linked to inherited thrombophilias studied at laboratories like Mayo Clinic Laboratories, acquired hypercoagulable states referenced in protocols from Centers for Disease Control and Prevention, and situational exposures recognized by organizations such as Professional Association of Diving Instructors.
Many individuals with patent foramen ovale are asymptomatic, a fact confirmed in population cohorts reported by researchers at Stanford University and University College London. Symptomatic presentations include cryptogenic Stroke and Transient ischemic attack, migraine with aura described in headache research from American Headache Society, and decompression sickness among divers reported in case series from Duke University Medical Center and military medicine publications from United States Navy. Complications such as paradoxical embolism, systemic arterial embolization to territories including the coronary or mesenteric circulations, and transient hypoxemia have been documented in clinical registries maintained by centers like Cleveland Clinic Foundation and in multicenter trials coordinated by groups including the European Society of Cardiology.
Diagnostic evaluation leverages transthoracic echocardiography and transesophageal echocardiography protocols developed at institutions such as Mayo Clinic and Johns Hopkins Hospital, often augmented by contrast studies (bubble study) and maneuvers derived from physiology labs at University of Pennsylvania. Transcranial Doppler, used in cerebrovascular programs at Massachusetts General Hospital and Charité – Universitätsmedizin Berlin, offers a noninvasive screen for right-to-left shunt. Cardiac catheterization and intracardiac echocardiography techniques pioneered at centers like Cleveland Clinic and Mount Sinai Hospital provide definitive anatomic delineation when percutaneous closure is contemplated.
Management strategies have evolved through randomized trials conducted by consortia involving National Institutes of Health funding and academic networks including Oxford University and Columbia University. Options include medical therapy with antiplatelet agents recommended in guidelines from bodies such as the American Heart Association and anticoagulation informed by evidence synthesized by the European Stroke Organisation. Percutaneous transcatheter closure using devices evaluated in trials at high-volume centers like Cleveland Clinic and Mayo Clinic is an option for selected patients with recurrent cryptogenic stroke, with device selection and procedural technique taught in interventional training at Stanford Health Care. Surgical closure remains rare and is performed at specialized cardiac surgery programs like Great Ormond Street Hospital for complex anatomy.
Outcomes depend on patient selection, comorbidities cataloged in databases at Framingham Heart Study and procedural expertise documented by registries from Society for Cardiovascular Angiography and Interventions. Randomized controlled trials and long-term follow-up from centers such as Massachusetts General Hospital and University of California, San Francisco have informed estimates of recurrent stroke reduction in selected populations, balanced against device-related complications reported in postmarket surveillance coordinated by agencies like the Food and Drug Administration and the European Medicines Agency.
The foramen ovale and its persistence were described in anatomical treatises of the 19th century and studied in collections at institutions like the Royal Society and British Museum (Natural History), with advances in imaging and intervention accelerating in the late 20th and early 21st centuries at centers including Mayo Clinic, Cleveland Clinic, and Johns Hopkins Hospital. Debates over indications for closure have engaged professional societies such as the American College of Cardiology and the European Society of Cardiology, and public awareness has been influenced by media reporting on high-profile cases treated at institutions like Mount Sinai Hospital and Massachusetts General Hospital. Legal and regulatory aspects of device approval involved agencies such as the Food and Drug Administration and public engagement through organizations like American Heart Association advocacy efforts.