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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, Elena Ladich, MD, Shannon Mackey-Bojack, MD, Jack Titus, MD, 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
CV Path, International Registry of Pathology, Gaithersburg, Maryland
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; 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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