Patent Foramen Ovale—A Not So Innocuous Septal Atrial Defect in Adults

Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15%–35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.

Download Full-text

Atrial septal aneurysms in childhood: prevalence, classification, and concurrent abnormalities

Cardiology in the Young ◽

10.1017/s1047951113000607 ◽

2013 ◽

Vol 24 (3) ◽

pp. 453-458 ◽

Cited By ~ 10

Author(s):

Andreas Giannopoulos ◽

Christoforos Gavras ◽

Stavroula Sarioglou ◽

Fotini Agathagelou ◽

Irene Kassapoglou ◽

...

Keyword(s):

Atrial Septal Defect ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Interatrial Septum ◽

Paediatric Population ◽

Point Of View ◽

Atrial Septal Aneurysm ◽

Foramen Ovale ◽

Increased Risk

AbstractObjectives: This study sought to investigate the prevalence of atrial septal aneurysms in the paediatric population and to define coexisting abnormalities and their incidence. Background: Few papers refer to the prevalence of atrial septal aneurysms in childhood. Methods: We enrolled a total of 4522 children aged more than 12 months who underwent a transthoracic echocardiography. Atrial septal aneurysm was defined as a protrusion of the interatrial septum or part of it >15 mm beyond the plane of the atrial septum or phasic excursion of the interatrial septum during the cardiorespiratory cycle of at least 15 mm in total amplitude and a diameter of the base of the aneurysm of at least 15 mm. Results: Atrial septal aneurysms were found in 47 children (1.04%). They involved almost the entire septum in 14 patients (28.89%) and were limited to the fossa ovalis in 33 (71.11%). An atrial septal aneurysm was an isolated structural defect in 17 (35.56%). In 30 (64.44%) patients, it was associated with interatrial shunting – atrial septal defect and patent foramen ovale. At the echo follow-up after a year, no changes were recorded. Conclusions: Prevalence of atrial septal aneurysms is almost 1%. The most common abnormalities associated are interatrial shunts, that is, a patent foramen ovale and an atrial septal defect. From a medical point of view, it is suggested that no action is to be taken during childhood, as a child with an atrial septal aneurysm is not at increased risk compared with a child without one. Follow-up is scheduled on an individual basis.

Download Full-text

Imaging Assessment of the Interatrial Septum for Transcatheter Atrial Septal Defect and Patent Foramen Ovale Closure

Interventional Cardiology Clinics ◽

10.1016/j.iccl.2017.05.004 ◽

2017 ◽

Vol 6 (4) ◽

pp. 505-524 ◽

Cited By ~ 1

Author(s):

Mary Z. Bechis ◽

David S. Rubenson ◽

Matthew J. Price

Keyword(s):

Atrial Septal Defect ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Interatrial Septum ◽

Foramen Ovale

Download Full-text

Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

The Heart Surgery Forum ◽

10.1532/hsf98.20041173 ◽

2005 ◽

Vol 8 (2) ◽

pp. 96 ◽

Cited By ~ 1

Author(s):

Osman Tansel Dar�in ◽

Alper Sami Kunt ◽

Mehmet Halit Andac

Keyword(s):

Atrial Septal Defect ◽

Right Atrium ◽

Septal Defect ◽

Complete Recovery ◽

Interatrial Septum ◽

Right Atrial ◽

Atrial Wall ◽

Residual Shunt ◽

Asd Closure ◽

The Right

Background: Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. Case: In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. Results: During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. Conclusion: Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

Download Full-text

Percutaneous Treatment of Congenital Defects of the Inter-atrial Septum in Adults – Recent Advances and Persistent Pitfalls

Interventional Cardiology Review ◽

10.15420/icr.2009.4.1.76 ◽

2009 ◽

Vol 4 (1) ◽

pp. 76

Author(s):

James Slater ◽

Mark Fisch ◽

◽

Keyword(s):

Atrial Septal Defect ◽

Adult Patient ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Percutaneous Treatment ◽

Atrial Septum ◽

Congenital Defects ◽

Foramen Ovale ◽

Anatomy And Physiology ◽

Specific Tissue

William Harvey was the first scientist to describe the heart as consisting of separate right- and left-sided circulations. Our understanding of the heart’s anatomy and physiology has grown significantly since this landmark discovery in 1628. Today, we recognise not only the importance of these separate systems, but also the specific tissue that divides them. Our growing understanding of the inter-atrial septum has allowed us to identify defects within this structure and develop effective percutaneous devices for closure of these defects in the adult patient. This article discusses the formation of a patent foramen ovale (PFO) and atrial septal defect (ASD). In addition, we describe the medical illnesses caused by these defects and summarise the indications and risks related to percutaneous closure of these defects. We also report the most up-to-date transcatheter therapeutic options for closure of these common congenital defects in the adult patient.

Download Full-text

Short- and long-term haemodynamic consequences of transcatheter closure of atrial septal defect and patent foramen ovale

Netherlands Heart Journal ◽

10.1007/s12471-021-01543-0 ◽

2021 ◽

Author(s):

X. Jin ◽

Y. M. Hummel ◽

W. T. Tay ◽

J. F. Nauta ◽

N. S. S. Bamadhaj ◽

...

Keyword(s):

Atrial Septal Defect ◽

Diastolic Function ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Transcatheter Closure ◽

Foramen Ovale ◽

Short And Long Term ◽

Interatrial Shunt ◽

Pfo Closure

Abstract Background Transcatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure might have opposite short- and long-term haemodynamic consequences compared with restricted interatrial shunt creation, which recently emerged as a potential treatment modality for patients with heart failure with preserved ejection fraction (HFpEF). Given the opposing approaches of ASD and PFO closure versus shunt creation, we investigated the early and sustained cardiac structural and functional changes following transcatheter ASD or PFO closure. Methods In this retrospective study, adult secundum-type ASD and PFO patients with complete echocardiography examinations at baseline and at 1‑day and 1‑year follow-up who also underwent transcatheter closure between 2013 and 2017 at the University Medical Centre Groningen, the Netherlands were included. Results Thirty-nine patients (mean age 48 ± standard deviation 16 years, 61.5% women) were included. Transcatheter ASD/PFO closure resulted in an early and persistent decrease in right ventricular systolic and diastolic function. Additionally, transcatheter ASD/PFO closure resulted in an early and sustained favourable response of left ventricular (LV) systolic function, but also in deterioration of LV diastolic function with an increase in LV filling pressure (LVFP), as assessed by echocardiography. Age (β = 0.31, p = 0.009) and atrial fibrillation (AF; β = 0.24, p = 0.03) were associated with a sustained increase in LVFP after transcatheter ASD/PFO closure estimated by mean E/e’ ratio (i.e. ratio of mitral peak velocity of early filling to diastolic mitral annular velocity). In subgroup analysis, this was similar for ASD and PFO closure. Conclusion Older patients and patients with AF were predisposed to sustained increases in left-sided filling pressures resembling HFpEF following ASD or PFO closure. Consequently, these findings support the current concept that creating a restricted interatrial shunt might be beneficial, particularly in elderly HFpEF patients with AF.

Download Full-text