Patent Foramen Ovale Differential Diagnoses

Sections

Patent Foramen Ovale

DDx

Diagnostic Considerations

Other considerations in patient with suspected patent foramen ovale (PFO) include the following:

Obstructive sleep apnea
Cardiac surgery
Hypoxemia increases in PFO due to transient elevation of right atrial pressure with an increase in right-to-left shunt resulting in systemic arterial desaturation.
In off-pump coronary artery bypass surgery, PFO increases the risk of postoperative atrial fibrillation and hypoxemia.

PFO is often associated with other cardiac anomalies, such as the following:

Atrial septal aneurysm: A redundant and mobile interatrial tissue in fossa ovalis that has phasic excursion of 10-15 mm during cardiorespiratory cycle.
Eustachian valve: Eustachian valve is located at junction of inferior vena cava and right atrium.
Chiari network: A fenestrated mobile structure consists of a network of threads and fibers in the right atrium that originate from the region of the Eustachian and thebesian valve at the orifice of inferior vena cava with attachments to upper wall of right atrium or atrial septum.
In a study by Schneider, 1436 consecutive patients were referred for TEE. A Chiari network was found in 29 subjects (2%), 24 (83%) had PFO, and 7 (24%) had an atrial septal aneurysm.^[12]
Atrial septal defect: In a study of 103 patients by Khositseth who were referred for transcatheter closure for a paradoxical embolism, PFO was present in 81 subjects , ASD in 12 subjects, and both PFO and ASD in 10 subjects.^[13]
Ebstein anomaly: In a study by Attenhofer of 106 patients, 79% had either persistent or previously closed PFO or atrial septal defect.^[14]

Workup

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Media Gallery

This 2-dimensional echocardiogram in an infant (subcostal long-axis view) shows a patent foramen ovale. Right atrium (RA) and left atrium (LA
Color Doppler of the patent foramen ovale (PFO) seen in the previous image. A small amount of left-to-right flow is present. This left-to-right flow pattern is typical for PFO seen in newborn infants
Color Doppler of the patent foramen ovale (PFO) seen in the previous image. A small amount of left-to-right flow is present. This left-to-right flow pattern is typical for PFO seen in newborn infants

of 3

Author

Sandy N Shah, DO, MBA, FACC, FACP, FACOI Cardiologist

Sandy N Shah, DO, MBA, FACC, FACP, FACOI is a member of the following medical societies: American College of Cardiology, American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Osteopathic Association, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marschall S Runge, MD, PhD Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Texas Medical Association, Southern Society for Clinical Investigation, American Federation for Clinical Research, Association of Professors of Medicine, Association of Professors of Cardiology, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Medical Research, American Heart Association

Disclosure: Received honoraria from Pfizer for speaking and teaching; Received honoraria from Merck for speaking and teaching; Received consulting fee from Orthoclinica Diagnostica for consulting.

Chief Editor

Yasmine S Ali, MD, FACC, FACP, MSCI President, Nashville Preventive Cardiology, PLLC; Assistant Clinical Professor of Medicine, Vanderbilt University School of Medicine

Yasmine S Ali, MD, FACC, FACP, MSCI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, National Lipid Association, Tennessee Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: MCG Health, LLC.

Additional Contributors

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.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthors Ahmed Alghamdi, MD, MB, BCh, FRCP(C) and Dawn M Calderon, DO to the development and writing of this article.

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