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J Am Coll Cardiol, 2005; 46:1768-1776, doi:10.1016/j.jacc.2005.08.038 (Published online 27 September 2005).
© 2005 by the American College of Cardiology Foundation
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EXPEDITED REVIEW: STATE-OF-THE-ART PAPER

Patent Foramen Ovale: Current Pathology, Pathophysiology, and Clinical Status

Hidehiko Hara, MD*, Renu Virmani, MD{dagger}, Elena Ladich, MD{dagger}, Shannon Mackey-Bojack, MD{ddagger}, Jack Titus, MD{ddagger}, Mark Reisman, MD§, William Gray, MD§, Masato Nakamura, MD||, Michael Mooney, MD*, Anil Poulose, MD* and Robert S. Schwartz, MD*,*

* Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota
{dagger} CV Path, International Registry of Pathology, Gaithersburg, Maryland
{ddagger} Jesse E. Edwards Registry of Cardiovascular Disease, St. Paul, Minnesota
§ Swedish Medical Center, Seattle, Washington
|| Division of Cardiovascular Medicine, Toho University Ohashi Hospital, Tokyo, Japan.

Manuscript received May 15, 2005; revised manuscript received June 16, 2005, accepted August 1, 2005.

* Reprint requests and correspondence: Dr. Robert S. Schwartz, Minnesota Cardiovascular Research Institute, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 620, Minneapolis, Minnesota. (Email: rss{at}rsschwartz.com).

Patent foramen ovale (PFO) is experiencing increased clinical interest as a congenital cardiac lesion persisting into adulthood. It is implicated in several serious clinical syndromes, including stroke, myocardial infarction, and systemic embolism. The PFO is now amenable to percutaneous interventional therapies, and multiple novel technologies are either available or under development for lesion closure. The PFO should be better understood to take advantage of emerging percutaneous treatment options. This paper reviews PFO anatomy, pathology, pathophysiology, and clinical impact and discusses current therapeutic options.

Abbreviations and Acronyms
  ASA = atrial septal aneurysm
  ASD = atrial septal defect
  DCS = decompression sickness
  INR = international normalized ratio
  MRI = magnetic resonance imaging
  PFO = patent foramen ovale
  TCD = transcranial Doppler
  TEE = transesophageal echocardiography
  TIA = transient ischemic attack
  TTE = transthoracic echocardiography




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