Skip to main content

When a PFO Is Discovered Incidentally

  • Chapter
  • First Online:
Patent Foramen Ovale

Abstract

With Patent Foramen Ovale occurring in 20–25 % of the adult population, it can often be discovered incidentally during a cardiac evaluation. How should these patients be counseled? Is further evaluation warranted to assess risk factors that may predict a future complication? Is treatment of any sort needed?

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Hagan PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984;59(1):17–20.

    Article  Google Scholar 

  2. Yahia AM, Shaukat A, Kirmani JF, Qureshi AI. Age is not a predictor of patent foramen ovale with right-to-left shunt in patients with cerebral ischemic events. Echocardiography. 2004;21:517–22.

    Article  PubMed  Google Scholar 

  3. Di Tullio MR, Jin Z, Russo C, Elkind MSV, Rundek T, Yoshita M, et al. Patent foramen ovale, subclinical cerebrovascular disease, and ischemic stroke in a population-based cohort. J Am Coll Cardiol. 2013;62:35–41.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Meissner I, Khandheria BK, Heit JA, Petty GW, Sheps SG, Schwartz GL, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol. 2006;47:440–5.

    Article  PubMed  Google Scholar 

  5. Fenster BE, Nguyen BH, Buckner JK, Freeman AM, Carroll JD. Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia. Am J Cardiol. 2013;112(8):1258–62.

    Article  PubMed  Google Scholar 

  6. Hoffmann A, Chockalingam P, Balint OH, Dadashev A, Dimopoulos K, Engel R. Cerebrovascular accidents in adult patients with congenital heart disease. Heart. 2010;96:1223–6.

    Article  CAS  PubMed  Google Scholar 

  7. Fischbein CA, Rosenthal A, Fischer EG, Nadas AS, Welch K. Risk factors of brain abscess in patients with congenital heart disease. Am J Cardiol. 1974;34:97–102.

    Article  CAS  PubMed  Google Scholar 

  8. Nanthakumar K, Graham AT, Robinson TI, Grande P, Pugash RA, Clarke JA, et al. Contrast echocardiography for detection of pulmonary arteriovenous malformations. Am Heart J. 2001;141:243–6.

    Article  CAS  PubMed  Google Scholar 

  9. Pfleger S, Konstantin Haase K, Stark S, Latsch A, Simonis B, Scherhag A, et al. Haemodynamic quantification of different provocation manoeuvres by simultaneous measurement of right and left atrial pressure: implications for the echocardiographic detection of persistent foramen ovale. Eur J Echocardiogr. 2001;2:88–93.

    Article  CAS  PubMed  Google Scholar 

  10. Torti SR, Billinger M, Schwerzmann M, Vogel R, Zbinden R, Windecker S, Seiler C. Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale. Eur Heart J. 2004;25:1014–20.

    Article  PubMed  Google Scholar 

  11. Barone DA, Krieger AC. Stroke and obstructive sleep apnea: a review. Curr Atheroscler Rep. 2013;15:334–8.

    Article  PubMed  Google Scholar 

  12. Johansson MC, Eriksson P, Peker Y, Hedner J, Rastam L, Lindblad U. The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea. Eur Respir J. 2007;29:149–55.

    Article  CAS  PubMed  Google Scholar 

  13. Ciccone A, Proserpio P, Roccatagliata DV, Nichelatti M, Gigli GL, Parati G, et al. Wake-up stroke and TIA due to paradoxical embolism during long obstructive sleep apnoeas: a cross-sectional study. Thorax. 2013;68:97–104.

    Article  PubMed  Google Scholar 

  14. Cushman M. Inherited risk factors for venous thrombosis. Hematology. 2005;44:452–7.

    Google Scholar 

  15. Habe K, Wada H, Matsumoto T, Ohishi K, Ikejiri M, Matsubara K, et al. Presence of antiphospholipid antibody is a risk factor in thrombotic events in patients with antiphospholipid syndrome or relevant diseases. Int J Hematol. 2013;97(3):345–50.

    Article  CAS  PubMed  Google Scholar 

  16. Rott H. Thrombotic risks of oral contraceptives. Curr Opin Obstet Gynecol. 2012;24:235–40.

    Article  PubMed  Google Scholar 

  17. James AH. Pregnancy-associated thrombosis. Hematology. 2009;1:277–85.

    Google Scholar 

  18. Ng SY, Sugarbaker DJ, Frendl G. Interatrial shunting after major thoracic surgery: a rare but clinically significant event. Ann Thorac Surg. 2012;93:1647–51.

    Article  PubMed  Google Scholar 

  19. Roberge S, Nicolaides KH, Demers S, Villa P, Bujold E. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol. 2013;41(5):491–9.

    Article  CAS  PubMed  Google Scholar 

  20. Barrack RL. Current guidelines for total joint VTE prophylaxis: dawn of a new day. J Bone Joint Surg Br. 2012;94(11 Suppl A):3–7.

    Article  CAS  PubMed  Google Scholar 

  21. O’Neill VJ, Jeffrey Evans TR, Preston J, Moss J, Kaye SB. A retrospective analysis of Hickman line-associated complications in patients with solid tumours undergoing infusional chemotherapy. Acta Oncol. 1999;38:1103–7.

    Article  PubMed  Google Scholar 

  22. DeSimone CV, Friedman PA, Noheria A, Patel NA, DeSimone DC, Bdeir A, et al. Stroke or transient ischemic attack in patients with transvenous pacemaker or defibrillator and echocardiographically detected patent foramen ovale. Circulation. 2013;​128(13):​1433–41.

    Article  PubMed  Google Scholar 

  23. Parsi K. Paradoxical embolism, stroke and sclerotherapy. Phlebology. 2012;27:147–67.

    Article  CAS  PubMed  Google Scholar 

  24. Carroll JD, Saver JL, Thaler DE, Smalling RW, Berry S, MacDonald LA, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med. 2013;368:1092–100.

    Article  CAS  PubMed  Google Scholar 

  25. Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, Coste J, Patent Foramen Ovale and Atrial Septal Aneurysm Study Group, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med. 2001;345(24):1740–6.

    Article  CAS  PubMed  Google Scholar 

  26. Rigatelli G, Dell’Avvocata F, Cardaioli P, Giordan M, Braggion G, Aggio S, et al. Permanent right-to-left shunt is the key factor in managing patent foramen ovale. J Am Coll Cardiol. 2011;58:2257–61.

    Article  PubMed  Google Scholar 

  27. Schuchlenz HW, Saurer G, Weihs W, Rehak P. Persisting eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events. J Am Soc Echocardiogr. 2004;17:231–3.

    Article  PubMed  Google Scholar 

  28. Rigatelli G, Dell’avvocata F, Braggion G, Giordan M, Chinaglia M, Cardaioli P. Persistent venous valves correlate with increased shunt and multiple preceding cryptogenic embolic events in patients with patent foramen ovale: an intracardiac echocardiographic study. Catheter Cardiovasc Interv. 2008;72:973–6.

    Article  PubMed  Google Scholar 

  29. Krasuski RA, Hart SA, Allen D, Qureshi A, Pettersson G, Houghtaling PL, et al. Prevalence and repair of intraoperatively diagnosed patent foramen ovale and association with perioperative outcomes and long-term survival. JAMA. 2009;302(3):290–7.

    Article  CAS  PubMed  Google Scholar 

  30. Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, Felberg R, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med. 2012;366(11):991–9.

    Article  CAS  PubMed  Google Scholar 

  31. Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013;368(12):1083–91.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert J. Sommer MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Sommer, R.J., Spencer, B.T. (2015). When a PFO Is Discovered Incidentally. In: Amin, Z., Tobis, J., Sievert, H., Carroll, J. (eds) Patent Foramen Ovale. Springer, London. https://doi.org/10.1007/978-1-4471-4987-3_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4987-3_16

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4986-6

  • Online ISBN: 978-1-4471-4987-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics