Ver el código de «Patent foramen ovale»

==Background==
*Flap-like opening between the atrial septa primum and secundum
*Occurs at fossa ovalis
*Persists beyond 1 year of age
*Inter-atrial communication allows right-to-left cardiac shunting
*Most patients with isolated PFO are asymptomatic
**But there is increasing evidence that PFO is the culprit in [[Missile embolism|paradoxical embolic events]]

==Clinical Features==
*[[Stroke]] or [[TIA]] of undefined etiology
**Consider in young, healthy patients without risk factors for stroke
*[[Migraine]] or migraine-like symptoms
*Neurologic [[decompression sickness]] (seen in scuba divers)
*[[Acute myocardial infarction]]
*Systemic [[thromboembolism|embolism]], such as renal infarction
*Fat embolism
*Paradoxical embolism caused by right atrial tumors that increase right atrial pressure
*Left-sided valve disease in [[carcinoid syndrome]]

==Differential Diagnosis==
{{Missile embolism types}}

==Evaluation==
*[[Echocardiography]]: color flow Doppler imaging
**Small "flame" of color signal may be seen in middle region of atrial septum
*[[Contrast echocardiography]] (Bubble Study)
**Bolus of agitated saline injected to antecubital vein
**Microbubbles appear in right atrium
***Study positive for PFO if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in right atrium 
**Valsalva increases right atrial pressure and facilitates right-to-left shunting if present
*2D TEE with contrast provides superior visualization and is preferred
**Obtain 2E TEE with constrast if suspicion is high and TTE is negative

==Management==
*Most patients with incidental or isolated PFO receive no treatment
*Treatment more common when PFO associated with unexplained neurologic event, but no consensus for treatment exists

===Medical Therapy===
*[[Aspirin]] therapy alone in low risk patients
*[[Warfarin]] with ASA (INR 2-3) in high-risk individuals

===Surgical Closure===
*Indications:
**PFO more than 25 mm in size
**Inadequate rim of tissue around defect
**Percutaneous device failure
*Advantages of surgical closure
**Permanent closure of defect
**Prevents future paradoxical emboli
**No need for long-term anticoagulation
*Percutaneous closure
**Emergency therapeutic option

==See Also==
*[[Congenital Heart Disease]]
*[[Missile embolism]]

==External Links==

==References==
<references/>
emedicine.Medscape.com

[[Category:Cardiology]]