Patent Foramen Ovale-A Not So Innocuous Septal Atrial Defect in Adults

Abstract

Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15-35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.

Keywords: atrial septal defect; decompression illness; diving; foramen ovale; patent foramen ovale.

Figure 1

Development of the interatrial septum and foramen ovale at the end of the fourth week (A), during the sixth week (B), and at the beginning of the seventh gestational week (C,D). Modified with permission [22].

Figure 2

Intraoperative view of an atrial septal defect, ostium secundum type. This defect can result from excessive resorption of the proximal part of the septum primum or the inadequate development of the septum secundum [1].

Figure 3

An example of patent foramen ovale, as observed in the subcostal view using color Doppler. The arrow indicates a small left-to-right atrial shunt.

Figure 4

An example of transcranial Doppler ultrasound with the agitated saline contrast, in which the microbubbles produce embolic signal within the middle cerebral artery.