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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
10:52

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Published on: December 23, 2022

Caught in the act: entrapped embolus through a patent foramen ovale

Alexander Hansen1, Helmut Kuecherer

  • 1Department of Cardiology and Angiology Kcinik Koesching, Koesching. alexander.hansen@klinik-koesching.de

European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology
|February 26, 2008
PubMed

Insights

A patent foramen ovale (PFO) is common and often diagnosed via echocardiography. Paradoxical embolism, where clots travel from the venous to arterial system through a PFO, is usually presumed but rarely directly observed.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Patent foramen ovale (PFO) is a frequent cardiac finding, often detected using transesophageal echocardiography.
  • Paradoxical embolism is a clinical diagnosis typically made when arterial emboli appear in a compatible setting.
  • The mechanism is presumed to involve venous thrombi traversing a PFO during transient right-to-left shunting.

Observation:

  • Direct visualization of thrombi passing through a PFO is uncommon.
  • Transesophageal echocardiography is a key diagnostic tool for identifying PFO.

Findings:

  • While the existence of paradoxical embolism is accepted, documented instances of thrombi traversing a PFO are scarce.
  • The presumptive diagnosis relies heavily on clinical context rather than direct evidence of passage.

Implications:

  • Understanding the direct visualization of thrombus passage through PFO is crucial for refining diagnostic criteria.
  • Further research may elucidate the frequency and mechanisms of paradoxical embolism.
  • Improved diagnostic certainty could impact treatment strategies for patients with PFO and embolic events.

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