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Canadian Journal of Cardiology

Detection of Patent Foramen Ovale: Identifying the “Holes” With Contrast-Enhanced Transthoracic Echocardiography

Published:September 25, 2022DOI:https://doi.org/10.1016/j.cjca.2022.09.021
      The presence of a patent foramen ovale (PFO) has been implicated in the pathogenesis of several clinical phenomena, including cryptogenic stroke, left-side paradoxic emboli, platypnea-orthodeoxia syndrome, left-side carcinoid valve disease, decompression illness in scuba divers, and migraine headaches.
      • Cho K.K.
      • Khanna S.
      • Lo P.
      • Cheng D.
      • Roy D.
      Persistent pathology of the patent foramen ovale: a review of the literature.
      Of these, cryptogenic stroke is the most researched, with 4 recent large randomised clinical trials
      • Lee P.H.
      • Song J.-K.
      • Kim J.S.
      • et al.
      Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO trial.
      • Saver J.L.
      • Carroll J.D.
      • Thaler D.E.
      • et al.
      Long-term outcomes of patent foramen ovale closure or medical therapy after stroke.
      • Søndergaard L.
      • Kasner S.E.
      • Rhodes J.F.
      • et al.
      Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke.
      • Mas J.-L.
      • Derumeaux G.
      • Guillon B.
      • et al.
      Patent foramen ovale closure or anticoagulation vs antiplatelets after stroke.
      demonstrating the benefit of PFO closure to prevent recurrent ischemic strokes. Although the other entities are less well studied, PFO closure has been used to treat many of those conditions with favourable results.
      • Giblett J.P.
      • Williams L.K.
      • Kyranis S.
      • Shapiro L.M.
      • Calvert P.A.
      Patent foramen ovale closure: state of the art.
      When a PFO is suspected as the pathophysiologic mechanism of a patient’s condition, demonstration of the PFO’s presence is critical to inform treatment decisions.
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