Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Abstract

Patent foramen ovale (PFO) is a common congenital cardiac abnormality when the opening of the interatrial septum is not closed in adulthood. This abnormality affects 25% of the general population. With the development of precision medicine, an increasing number of clinical studies have reported that PFO is closely related to various neurological diseases such as stroke, migraine, obstructive sleep apnea, and decompression syndrome. It has also been suggested that PFO closure could be effective for preventing and treating these neurological diseases. Therefore, increasing attention has been given to the prevention, diagnosis, and treatment of PFO-related neurological diseases. By reviewing existing literature, this article focuses on the pathogenesis, epidemiology, and clinical characteristics of PFO-related neurological diseases, as well as the prevention and treatment of different neurological diseases to discuss, and aims to provide current progress for this field and decision-making evidence for clinical practice.

Transcranial Doppler Ultrasound and Transesophageal Echocardiography for Intraoperative Diagnosis and Monitoring of Patent Foramen Ovale in Non-Cardiac Surgery

“…cTTE confirmed the PFO diagnosis when the left ventricular bubble appeared within the first 3-5 cardiac cycles after right ventricular opacification. TCCD confirms the diagnosis when at least one bubble appears <25 s after injection with stirred saline [7,8].…”

“…In clinical practice, prophylactic antiplatelet and anticoagulant therapy are often suspended in the perioperative period due to the risk of bleeding. As pointed out by Ng et al [4], further studies are needed to examine whether these patients would benefit from intensified stroke prevention measures in the perioperative and intraoperative periods as they have an increased risk of developing neurological complications [7].…”

“…Other PFO-related neurological diseases have been reported such as migraine, sleepdisordered breathing, and cognitive dysfunction [7]. Some authors investigated whether a PFO was associated with an increased risk of postoperative delirium; however, given the very low incidence of PFO and postoperative delirium, they were could not draw any conclusions [10,27].…”