Patent foramen ovale in children: Unique pediatric challenges and lessons learned from adult literature

Abstract

A patent foramen ovale (PFO) is a frequent incidental finding during echocardiography in otherwise healthy children. In most healthy children with a diagnosis of isolated incidental PFO, no further follow-up or intervention is necessary. In some children, PFO is associated with certain clinical syndromes such as cryptogenic stroke, decompression sickness, migraine, and platypnea-orthodeoxia syndrome. This review discusses PFO anatomy, diagnostic imaging, PFO-associated clinical situations, management options, and the role of PFO in certain congenital heart disease. This review also highlights the current deficiency of pediatric data guiding management of these uncommon but important PFO-associated conditions. Future multicenter randomized controlled studies are necessary to guide the management of these unique and challenging PFO-associated conditions.

Keywords: Children; decompression sickness; management; migraine; patent foramen ovale; platypnea–orthodeoxia syndrome; stroke.

Figure 1

Transthoracic echocardiogram image from the subcostal sagittal plane showing patent foramen ovale (marked with asterisk). RA: Right atrium, LA: Left atrium, SVC: Superior vena cava, IVC: Inferior vena cava

Figure 2

Transthoracic echocardiogram image from the subcostal coronal plane showing patent foramen ovale (marked with asterisk) with atrial level left-to-right shunt. RA: Right atrium, LA: Left atrium

Figure 3

Transthoracic echocardiogram image from the subcostal plane showing patent foramen ovale (marked with asterisk) with atrial level right-to-left shunt. RA: Right atrium, LA: Left atrium, SVC: Superior vena cava

Figure 4

Transthoracic echocardiogram image from the subcostal plane showing patent foramen ovale (marked with asterisk) with atrial level right-to-left shunt. RA: Right atrium, LA: Left atrium, RV: Right ventricle, LV: Left ventricle