2023-10-07 08:21:21
The foramen ovale is the most frequent congenital anomaly of the heart and consists of the communication between the two atrial chambers. Intervention is not always necessary
I am the mother of a 25-year-old who, after two isolated episodes of headache with scotomas (lacunar defects of the visual field), was diagnosed with PFO (patent foramen ovale). Echocardiography, with and without contrast medium, reveals the presence of PFO with baseline flow reversal during and after the Warsaw maneuver. >20mb: a major PFO? Is the size of the PFO already a reason to intervene with the closure? Opinions are divided and we are confused. My daughter is fine, she has never had fainting spells, nor any particular tiredness after sport, the MRI and blood tests are fine and the ECG too.
Daniela Trabattoni answers Interventional Cardiology Unit Director Irccs Monzino Cardiology Center, Milan (GO TO THE FORUM)
The occasional/random finding of patency of the foramen ovale during instrumental diagnostic tests is not in itself an indication for percutaneous correction of the defect. PFO is a congenital defect present from birth in 20-25% of the population. The foramen ovale is the most frequent congenital anomaly of the heart, with which an enormous multitude of people live, without being aware of it, carriers of this small communication between the two atrial chambers, a legacy of intrauterine life. however, it is always better to know that you are a carrier of PFO in cases where this structural anomaly materializes as a pathology, becoming responsible for complications and neurological accidents, which today are absolutely predictable and avoidable.
The patent foramen ovale does not prevent you from having a normal active life; The only thing that is not recommended is scuba diving due to the risk of embolism secondary to decompression during ascent. The indications for the correction of the same, according to international guidelines and in accordance with the European Position Document published last year, take into account the anamnestic history of the subject and the individual risk profile evaluated in light of the anatomical data, the extent of the shunt intracardiac, the presence of structural alterations on MRI/CT scan of the brain, coagulation disorders and positive thrombophilic screening.
Therefore, an occasional finding of PFO not associated with any symptoms does not constitute a sufficient element for a correction by percutaneous implantation of an occlusion device. There is a correlation between migraine with aura and patent foramen ovale, however, even in this case, isolated episodes of migraine are not sufficient to establish treatment indications. Finally, the evaluation of any prophylactic antiplatelet therapy must be evaluated by the attending physician or cardiologist in individual cases.
October 7, 2023 (modified October 7, 2023 | 08:21)
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