Editorial

Patent Foramen Ovale

Authors: Michael Koger, Sr, MD

Abstract

Patent foramen ovale is common in the general population and even more common in patients with cryptogenic stroke or stroke of unknown cause. The most common causes of stroke in people over the age of 50 are atherosclerosis and atrial fibrillation. In patients under the age of 50 who develop stroke of undetermined cause, one should entertain the possibility of a patent foramen ovale.1 The foramen ovale is open during embryonic development and should close by the neonatal period. In 26 to 29% of the population, it remains open after birth and continues to be patent through life, creating a shunt between the two atria. Valsalva maneuver from straining may raise the right atrial pressure and cause a right-to-left shunt. What is the best approach to managing patients with this cardiac defect? Surgical closure, percutaneous transcatheter closure, antiplatelet agents and anticoagulants have all demonstrated benefit in its management.2

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References

1. Wu L, Malouf JMD, Dearani D. Patent foramen ovale in cryptogenic stroke: Current understanding and management options. Arch Intern Med 2004;164:950–956.
 
2. Dearani J, Ugurlu B, Danielson G, et al. Surgical patent foramen ovale closure for prevention of paradoxical embolism—related cerebrovascular ischemic events. Circulation 1999;100:171–175.
 
3. Homma SMD, Sacco R, DiTullio M, et al. Effect of medical treatment in stroke patients with patent foramen ovale. Circulation 2002;105:2625.
 
4. Meir B, Lock J. Contemporary management of patent foramen ovale. Circulation 2003;107:5.
 
5. Martin F, Sánchez P, Doherty E, et al. Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism. Circulation 2002;106:1121.