Patent foramen ovale: a review of associated conditions and the impact of physiological size
Edmund K. Kerut, MD, FACC*,
William T. Norfleet, MD ,
Gary D. Plotnick, MD, FACC and
Thomas D. Giles, MD, FACC*
* Cardiovascular Research Laboratory, Division of Cardiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
National Aeronautics and Space Administration, Johnson Space Center, Houston, Texas, USA
Division of Cardiology, University of Maryland Hospitals, Baltimore, Maryland, USA
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Figure 1 Longitudinal imaging transesophageal echocardiography in the midupper esophagus. A large patent foramen ovale (PFO) is evident. The arrow illustrates how to measure the PFO width. LA = left atrium; RA = right atrium.
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Figure 2 M-mode (left) and two-dimensional (right) transesophageal echocardiography longitudinal image in the midupper esophagus. The M-mode demonstrates marked interatrial septum (IAS) mobility, with an excursion >15 mm. By definition this is an atrial septem aneurysm. LA = left atrium; RA = right atrium; SVC = superior vena cava.
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Figure 3 Transesophageal echocardiography in the midupper esophagus at 105°. The arrow points to the mobile Chiari network. IAS = interatrial septum; LA = left atrium; RA = right atrium; SVC = superior vena cava.
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Figure 4 Longitudinal transesophageal echocardiography imaging in the midupper esophagus with color Doppler. Blue color is inferior vena cava (IVC) flow directed along the interatrial septum (IAS). Prominent IVC flow may prevent contrast injected in an upper extremity from opacifying the septum along the IAS.
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Figure 5 Longitudinal transesophageal echocardiography (TEE) imaging in the midupper esophagus. A 32-year-old male presented with an embolic stroke. He was found to have occult thrombi in both calf veins. Transthoracic echocardiography with peripheral saline contrast during normal respiration and Valsalva were negative for a right-to-left shunt. (A) TEE revealed a small restrictive secundum atrial septal defect (ASD) (arrow). Note how this appearance is different from that of a patent foramen ovale. (B) Color Doppler demonstrates a left-to-right shunt with a color mosaic pattern from the shunt in the right atrium (RA). The ASD was subsequently surgically repaired. LA = left atrium; SVC = superior vena cava.
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Figure 6 Longitudinal transesophageal echocardiographic imaging in the midupper esophagus. Arrows point to a thrombus wedged through a patent foramen ovale and lodged in both the right atrium (RA) and left atrium (LA). SVC = superior vena cava.
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