eMedicine Specialties > Cardiology > Congenital Heart Disease in the Adult

Patent Foramen Ovale: Follow-up

Author: Sandy N Shah, DO, MBA, Private Practice, Houston, Texas
Coauthor(s): Dawn M Calderon, DO, Co-Director of Center for Adults With Congenital Heart Disease, Clinical Associate Professor, Departments of Cardiology and Internal Medicine, Deborah Heart and Lung Center, Robert Wood Johnson School of Medicine
Contributor Information and Disclosures

Updated: May 1, 2008

Follow-up

Inpatient & Outpatient Medications

Aspirin or warfarin is required for 6 months following closure of patent foramen ovale (PFO) during cardiac catheterization.

Complications

  • Complications of catheter-based closure of PFO, such as embolism of device, device entrapment within the Chiari network, frame fracture, vessel damage, or perforation of atrial wall, may require further surgery.
  • Other possible complications include air embolism during device delivery, thrombus formation around the device, and infective endocarditis.

Miscellaneous

Medicolegal Pitfalls

  • Patent foramen ovale (PFO) is often considered in the differential diagnosis of cryptogenic stroke. At present, no consensus guidelines exist for the treatment of PFO. The following issues remain unsettled:
    • Treatment of asymptomatic patients with PFO
    • Duration of medical therapy after stroke or transient ischemic event
    • Optimal time to close PFO
  • In the setting of PFO, risk of stroke recurrence is not trivial. Risk associated with long-term anticoagulation is also not trivial. Surgical closure reduces the risk of stroke recurrence from PFO and reduces the need for anticoagulation. Catheter-based techniques are an emerging option for closing PFO.

Special Concerns

  • Misconceptions: Clinicians must know what a PFO is and what it is not.
    • The defect in PFO is not a result of missing tissue; therefore, very specific hemodynamics must be present (ie, right atrial pressure exceeding left atrial pressure) for shunting to occur.
    • PFO is not associated with an increased risk of endocarditis. Antibiotic prophylaxis is not indicated.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Ahmed Alghamdi, MD, MB, BCh, FRCP(C) to the development and writing of this article.



More on Patent Foramen Ovale

Overview: Patent Foramen Ovale
Differential Diagnoses & Workup: Patent Foramen Ovale
Treatment & Medication: Patent Foramen Ovale
Follow-up: Patent Foramen Ovale
References
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References

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Further Reading

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Keywords

patent foramen ovale, PFO, paradoxical embolism, atrial septum primum, atrial septum secundum, fossa ovalis, atrial septal aneurysm, right-to-left shunt, stroke, transient ischemic event, Valsalva maneuver, atrial septal aneurysm, cryptogenic stroke, paradoxical embolization

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Contributor Information and Disclosures

Author

Sandy N Shah, DO, MBA, Private Practice, Houston, Texas
Sandy N Shah, DO, MBA is a member of the following medical societies: American College of Cardiology, American Heart Association, and American Osteopathic Association
Disclosure: Nothing to disclose.

Coauthor(s)

Dawn M Calderon, DO, Co-Director of Center for Adults With Congenital Heart Disease, Clinical Associate Professor, Departments of Cardiology and Internal Medicine, Deborah Heart and Lung Center, Robert Wood Johnson School of Medicine
Dawn M Calderon, DO is a member of the following medical societies: American College of Cardiology and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Park W Willis IV, MD, Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine
Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Marschall S Runge, MD, PhD, Charles and Anne Sanders Distinguished Professor of Medicine, Chairman of Medicine, Vice Dean for Clinical Affairs, Chairman, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association
Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Park W Willis IV, MD, Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine
Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography
Disclosure: Nothing to disclose.

 
 
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