Patent Foramen Ovale: Epidemiology, Risk Factors, Pathophysiology, Clinical Features, Diagnosis, and Management

Patent foramen ovale (PFO) is a highly prevalent cardiac abnormality, affecting approximately 25% of the population worldwide. Although a PFO may be discovered incidentally and remain asymptomatic throughout life, it can also be a conduit for paradoxical emboli or vasoactive substances and has been associated with neurological disorders, including cryptogenic stroke, transient ischemic attack, migraine, epilepsy, as well as systemic embolism, hypoxemic disorders, and decompression sickness, particularly in individuals with high-risk anatomy or traditional cardiovascular risk factors. However, accurate identification of pathogenic PFO remains a challenge in current clinical practice, and the indications, timing, and long-term safety of PFO closure remain controversial. In this review, we summarize the epidemiology, risk factors, pathophysiological mechanisms, clinical manifestations, diagnostic strategies, and management of PFO, with particular emphasis on risk stratification, emerging imaging tools, novel closure devices, procedure-related complications, and the application of closure in special populations. In addition, we focused on the current evidence regarding when and who may benefit from PFO intervention and the surveillance of postprocedural complications. Overall, this review provides a comprehensive overview of the current findings and future perspectives for the management of PFO.