Patent Foramen Ovale (PFO)

  • Azin AlizadehaslEmail author
  • Anita Sadeghpour


A patent foramen ovale (PFO) is an anatomical communication between two atria with a possibility for right-to-left shunt. PFO is a flap-like opening between the atrial septa primum and secundum at the site of the fossa ovalis that persists after 1 year of age. In utero, the foramen ovale helps as a physiologic conduit for right-to-left shunting. After birth, once the pulmonary circulation is established, left atrial (LA) pressure increases, permitting functional closure of the foramen ovale. This is followed by an anatomical closure by the age of 1 year [1, 2].


Patent foramen ovale (PFO) Fossa ovalis Atrial septum pimum Atrial septum secundum Contrast echocardiography Transient ischemic attack (TIA) 

Supplementary material

Video 54.1

PFO in transesophageal echocardiography by 2D study in the middle area of the inter-atrial septum (MPG 4856 kb)

Video 54.2

PFO in transesophageal echocardiography by color flow imaging (MPG 978 kb)

Video 54.3

Agitated-saline injection into an ante-cubital vein showing many bubble passage from interatrial septum within three cardiac cycles of their appearance in the RA suggestive of PFO (MPG 4688 kb)


  1. 1.
    Kerut EK, Norfleet WT, Plotnick GD, et al. Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol. 2001;38(3):613–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Aslam F, Shirani J, Haque AA. Patent foramen ovale: assessment, clinical significance and therapeutic options. South Med J. 2006;99(12):1367–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Thaler DE, Ruthazer R, Di Angelantonio E, et al. Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale. Stroke. 2013;44(3):675–80.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Agostoni P, Gasparini G, Destro G. Acute myocardial infarction probably caused by paradoxical embolus in a pregnant woman. Heart. 2004;90(3):e12.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Sievert H, Taaffe M. Patent foramen ovale: the jury is still out. Eur Heart J. 2004;25(5):361–2.PubMedCrossRefGoogle Scholar
  6. 6.
    Maffe S, Dellavesa P, Zenone F, et al. Transthoracic second harmonic two- and three-dimensional echocardiography for detection of patent foramen ovale. J Am Coll Cardiol Intv. 2010;3(9):968–73.Google Scholar
  7. 7.
    Shanks M, Manawadu D, Vonder Muhll I, Khan K, Becher H, Choy J. Detection of patent foramen ovale by 3D echocardiography. JACC Cardiovasc Imaging. 2012;5(3):329–31.PubMedCrossRefGoogle Scholar
  8. 8.
    Danzi GB, Sesana M, Capuano C, et al. Percutaneous closure of patent foramen ovale: pathophysiology, indications, and technique. Neurol Sci. 2003;24 Suppl 1:S17–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Meier B, Lock JE. Contemporary management of patent foramen ovale. Circulation. 2003;107(1):5–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Khositseth A, Cabalka AK, Sweeney JP, Fortuin FD, Reeder GS, Connolly HM, et al. Transcatheter Amplatzer device closure of atrial septal defect and patent foramen ovale in patients with presumed paradoxical embolism. Mayo Clin Proc. 2004;79(1):35–41.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Echocardiography Lab, Department of CardiologyRajaie Cardiovascular Medical and Research Center, Iran University of Medical ScienceTehranIran
  2. 2.Echocardiography Lab, Department of CardiologyAdult Congenital Heart Disease Clinic, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical ScienceTehranIran

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