Patent foramen ovale - Revision history

ClaireLewis at 16:07, 25 September 2019

2019-09-25T16:07:22Z

← Older revision		Revision as of 16:07, 25 September 2019
Line 11:		Line 11:
	**Consider in young, healthy patients without risk factors for stroke		**Consider in young, healthy patients without risk factors for stroke
	*[[Migraine]] or migraine-like symptoms		*[[Migraine]] or migraine-like symptoms
	*Neurologic decompression sickness (seen in scuba divers)		*Neurologic [[decompression sickness]] (seen in scuba divers)
	*[[Acute myocardial infarction]]		*[[Acute myocardial infarction]]
	*Systemic embolism, such as renal infarction		*Systemic [[thromboembolism\|embolism]], such as renal infarction
	*Fat embolism		*Fat embolism
	*Paradoxical embolism caused by right atrial tumors that increase right atrial pressure		*Paradoxical embolism caused by right atrial tumors that increase right atrial pressure
Line 22:		Line 22:

	==Evaluation==		==Evaluation==
	*~~Color~~ flow Doppler imaging		*[[Echocardiography]]: color flow Doppler imaging
	**Small "flame" of color signal may be seen in middle region of atrial septum		**Small "flame" of color signal may be seen in middle region of atrial septum
	*[[Contrast echocardiography]] (Bubble Study)		*[[Contrast echocardiography]] (Bubble Study)

SLuckettG: /* Management */

2019-03-09T04:01:02Z

Management

← Older revision		Revision as of 04:01, 9 March 2019
Line 33:		Line 33:

	==Management==		==Management==
	Most patients with PFO ~~as isolated findings~~ receive no treatment.		*Most patients with incidental or isolated PFO receive no treatment
	~~When~~ PFO is associated with ~~an otherwise~~ unexplained neurologic event, no consensus for treatment exists		*Treatment more common when PFO associated with unexplained neurologic event, but no consensus for treatment exists

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

	===Surgical ~~Care~~===		===Surgical Closure===
	Indications ~~for surgical closure of PFO~~		*Indications:
	*PFO more than 25 mm in size		**PFO more than 25 mm in size
	*Inadequate rim of tissue around defect		**Inadequate rim of tissue around defect
	*~~percutaneous~~ device failure		**Percutaneous device failure
	Advantages of surgical closure		*Advantages of surgical closure
	*~~permanent~~ closure of defect		**Permanent closure of defect
	*~~prevents~~ future paradoxical emboli		**Prevents future paradoxical emboli
	*no long-term anticoagulation ~~and its risks~~		**No need for long-term anticoagulation
	Percutaneous closure ~~of PFO during cardiac catheterization is an emerging~~ therapeutic option.		*Percutaneous closure
			**Emergency therapeutic option

	==See Also==		==See Also==

SLuckettG: /* Evaluation */

2019-03-09T03:58:15Z

Evaluation

← Older revision		Revision as of 03:58, 9 March 2019
Line 22:		Line 22:

	==Evaluation==		==Evaluation==
	*Color flow Doppler imaging~~: small~~ "flame" of color signal may be seen in middle region of atrial septum		*Color flow Doppler imaging
	*[[Contrast echocardiography]] (Bubble Study)~~: After obtaining optimal visualization of atrial septum on TTE or TEE, a bolus~~ of agitated saline is injected to an antecubital vein~~. Subsequently, microbubbles~~ appear in ~~the~~ right atrium~~. The study is~~ positive for PFO if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in ~~the~~ right atrium. Valsalva increases right atrial pressure and facilitates right-to-left shunting if present.		**Small "flame" of color signal may be seen in middle region of atrial septum
	*2D TEE with contrast provides superior visualization and is ~~therefore~~ preferred ~~for detecting PFO. When clinically indicated, 2D~~ TEE with ~~contrast~~ is ~~strongly recommended if transthoracic echo~~ is negative.		*[[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==		==Management==

SLuckettG: /* Clinical Features */

2019-03-09T03:55:47Z

Clinical Features

← Older revision		Revision as of 03:55, 9 March 2019
Line 8:		Line 8:

	==Clinical Features==		==Clinical Features==
	*~~History of~~ [[~~stroke~~]] or [[TIA]] of undefined etiology		*[[Stroke]] or [[TIA]] of undefined etiology
			**Consider in young, healthy patients without risk factors for stroke
	*[[Migraine]] or migraine-like symptoms		*[[Migraine]] or migraine-like symptoms
	*Neurologic decompression sickness (seen in scuba divers)		*Neurologic decompression sickness (seen in scuba divers)

SLuckettG: /* Background */

2019-03-09T03:54:49Z

Background

← Older revision		Revision as of 03:54, 9 March 2019
Line 1:		Line 1:
	==Background==		==Background==
	~~Patent foramen ovale (PFO) is a flap~~-like opening between the atrial septa primum and secundum at ~~the location of the~~ fossa ovalis ~~that persists after~~ 1 year of age~~. This inter~~-atrial communication ~~gives potential for~~ right-to-left shunting ~~in the cardiovascular system. Although most~~ patients with an isolated PFO are asymptomatic, there is increasing evidence ~~being found~~ that PFO is the culprit in [[Missile embolism\|paradoxical embolic events]] ~~and therefore, the relative importance of the anomaly is being re-evaluated.~~		*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==		==Clinical Features==

ClaireLewis: /* Clinical Features */

2016-09-07T15:55:13Z

Clinical Features

← Older revision		Revision as of 15:55, 7 September 2016
Line 10:		Line 10:
	*Fat embolism		*Fat embolism
	*Paradoxical embolism caused by right atrial tumors that increase right atrial pressure		*Paradoxical embolism caused by right atrial tumors that increase right atrial pressure
	*Left-sided valve disease in carcinoid syndrome		*Left-sided valve disease in [[carcinoid syndrome]]

	==Differential Diagnosis==		==Differential Diagnosis==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T08:01:58Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 08:01, 25 July 2016
Line 15:		Line 15:
	{{Missile embolism types}}		{{Missile embolism types}}

	==~~Diagnosis~~==		==Evaluation==
	*Color flow Doppler imaging: small "flame" of color signal may be seen in middle region of atrial septum		*Color flow Doppler imaging: small "flame" of color signal may be seen in middle region of atrial septum
	*[[Contrast echocardiography]] (Bubble Study): After obtaining optimal visualization of atrial septum on TTE or TEE, a bolus of agitated saline is injected to an antecubital vein. Subsequently, microbubbles appear in the right atrium. The study is positive for PFO if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in the right atrium. Valsalva increases right atrial pressure and facilitates right-to-left shunting if present.		*[[Contrast echocardiography]] (Bubble Study): After obtaining optimal visualization of atrial septum on TTE or TEE, a bolus of agitated saline is injected to an antecubital vein. Subsequently, microbubbles appear in the right atrium. The study is positive for PFO if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in the right atrium. Valsalva increases right atrial pressure and facilitates right-to-left shunting if present.

Rossdonaldson1: /* Diagnosis */

2016-07-04T20:19:49Z

Diagnosis

← Older revision		Revision as of 20:19, 4 July 2016
Line 11:		Line 11:
	*Paradoxical embolism caused by right atrial tumors that increase right atrial pressure		*Paradoxical embolism caused by right atrial tumors that increase right atrial pressure
	*Left-sided valve disease in carcinoid syndrome		*Left-sided valve disease in carcinoid syndrome

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

	==Diagnosis==		==Diagnosis==

Rossdonaldson1: /* Diagnosis */

2016-07-04T20:17:12Z

Diagnosis

← Older revision		Revision as of 20:17, 4 July 2016
Line 14:		Line 14:
	==Diagnosis==		==Diagnosis==
	*Color flow Doppler imaging: small "flame" of color signal may be seen in middle region of atrial septum		*Color flow Doppler imaging: small "flame" of color signal may be seen in middle region of atrial septum
	*Contrast echocardiography ([[Bubble Study]]): After obtaining optimal visualization of atrial septum on TTE or TEE, a bolus of agitated saline is injected to an antecubital vein. Subsequently, microbubbles appear in the right atrium. The study is positive for PFO if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in the right atrium. Valsalva increases right atrial pressure and facilitates right-to-left shunting if present.		*[[Contrast echocardiography]] (Bubble Study): After obtaining optimal visualization of atrial septum on TTE or TEE, a bolus of agitated saline is injected to an antecubital vein. Subsequently, microbubbles appear in the right atrium. The study is positive for PFO if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in the right atrium. Valsalva increases right atrial pressure and facilitates right-to-left shunting if present.
	*2D TEE with contrast provides superior visualization and is therefore preferred for detecting PFO. When clinically indicated, 2D TEE with contrast is strongly recommended if transthoracic echo is negative.		*2D TEE with contrast provides superior visualization and is therefore preferred for detecting PFO. When clinically indicated, 2D TEE with contrast is strongly recommended if transthoracic echo is negative.

Rossdonaldson1: /* Diagnosis */

2016-07-04T20:16:40Z

Diagnosis

← Older revision		Revision as of 20:16, 4 July 2016
Line 14:		Line 14:
	==Diagnosis==		==Diagnosis==
	*Color flow Doppler imaging: small "flame" of color signal may be seen in middle region of atrial septum		*Color flow Doppler imaging: small "flame" of color signal may be seen in middle region of atrial septum
	*Contrast echocardiography (Bubble Study): After obtaining optimal visualization of atrial septum on TTE or TEE, a bolus of agitated saline is injected to an antecubital vein. Subsequently, microbubbles appear in the right atrium. The study is positive for PFO if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in the right atrium. Valsalva increases right atrial pressure and facilitates right-to-left shunting if present.		*Contrast echocardiography ([[Bubble Study]]): After obtaining optimal visualization of atrial septum on TTE or TEE, a bolus of agitated saline is injected to an antecubital vein. Subsequently, microbubbles appear in the right atrium. The study is positive for PFO if microbubbles appear in left atrium within 3 cardiac cycles of their appearance in the right atrium. Valsalva increases right atrial pressure and facilitates right-to-left shunting if present.
	*2D TEE with contrast provides superior visualization and is therefore preferred for detecting PFO. When clinically indicated, 2D TEE with contrast is strongly recommended if transthoracic echo is negative.		*2D TEE with contrast provides superior visualization and is therefore preferred for detecting PFO. When clinically indicated, 2D TEE with contrast is strongly recommended if transthoracic echo is negative.