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Patent Foramen Ovale in Children: A Review of Recent Progress
Tingting Zhang1, Chao Gao1, Wei Chen1
1Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Changle West Road, Xi'an, 710032, China.
Insights
Patent foramen ovale (PFO) in children requires careful consideration, as it may link to stroke and other conditions. Treatment is typically unnecessary for isolated PFO, but consultation is advised for complex cases.
Area of Science:
- Cardiology
- Pediatric Neurology
- Medical Imaging
Background:
- Management guidelines for patent foramen ovale (PFO) exist for adults, but optimal pediatric PFO treatment remains unclear.
- PFO is associated with various clinical syndromes and potential complications in children, including cryptogenic stroke and paradoxical embolization.
Purpose of the Study:
- To comprehensively analyze the clinical syndromes, imaging diagnosis, and management of PFO in pediatric patients.
- To review current evidence on the association between PFO and specific pediatric conditions.
- To provide guidance on the diagnostic and therapeutic approaches for PFO in children.
Main Methods:
- A comprehensive literature search was conducted across major electronic databases (PubMed, Cochrane, Web of Science, EMBASE) up to February 1st, 2024.
- 54 relevant articles were selected from an initial pool of 583 for in-depth review.
- Evidence regarding PFO's role in pediatric stroke, migraine, sickle cell disease, and rare syndromes was systematically evaluated.
Main Results:
- A right-to-left shunt through PFO is implicated in cryptogenic stroke in children, though its link to migraine with aura lacks robust evidence.
- Children with sickle cell disease and PFO face increased risk of paradoxical embolization; rare syndromes like platypnea-orthodeoxia syndrome, myocardial infarction, and decompression sickness can occur.
- Contrast transthoracic echocardiography is recommended for pediatric PFO diagnosis due to its efficacy and avoidance of anesthesia.
Conclusions:
- Isolated PFO in children generally does not require additional treatment due to a lack of evidence for future complications.
- For children with PFO in unique circumstances, a customized interdisciplinary consultation is crucial before considering medical interventions.
- Further research may be needed to clarify the long-term implications and optimal management strategies for PFO in pediatric populations.
Abstract:
The support has been provided by clinical trials and guidelines for managing patent foramen ovale (PFO) in adults; however, the optimal approach is still unclear for treating PFO in pediatric patients. PFO and its associated clinical syndromes, imaging diagnosis, and management in pediatric patients were analyzed by a comprehensive analysis. Extensive research was performed using electronic databases, including PubMed, Cochrane, Web of Science, and EMBASE. This review includes the studies published until February 1st, 2024. A total of 583 articles were obtained, of which 54 were included in the comprehensive review. Numerous evidences have indicated that a right-to-left shunt through a PFO may be involved in cryptogenic stroke in children, although the connection between migraine and aura has not been substantiated by robust evidence. Children with sickle cell disease and a PFO were at higher risks of paradoxical embolization, rare syndromes caused by PFO could also occur in children such as platypnea-orthodeoxia syndrome, myocardial infarction, and decompression sickness. Contrast transthoracic echocardiography was deemed the most appropriate examination for children due to its favorable transthoracic windows, eliminating the need for anesthesia. This review suggested that the additional treatment was not needed as no evidence was provided for potential future complications linked to isolated PFO in children. For children facing unique circumstances related to PFO, a customized interdisciplinary consultation is essential prior to considering medical interventions.
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