Patent foramen ovale: a comprehensive review for pulmonologists

PURPOSE OF REVIEW: A comprehensive review of the main concepts about patent foramen ovale (PFO) management is offered. RECENT FINDINGS: PFO is a common, usually benign, anatomical variant that in the presence of a discrete right-to-left shunt and other predisposing factors (Eustachian valve/Chiari network, atrial septal aneurysm, and coagulation cascade abnormalities) may play an important role in the patho-physiology of paradoxical embolism at different levels (cryptogenic stroke, peripheral embolism, coronary embolism, etc.). Therapy is a controversial issue, since data on these patients are variable and accepted guidelines are missing. Recurrent strokes are the most diffuse and accepted indication for transcatheter closure of PFO, but severe refractory migraine with aura, unexplained oxygen desaturation, orthodeoxia-platypnea, and other conditions have been suggested to benefit from PFO closure. Different devices and techniques have been proposed for this procedure, mainly depending on operator experience and preferences, which have contributed to this intervention becoming a well tolerated and effective procedure with very low morbidity and virtually absent mortality. SUMMARY: PFO management is still a debated field: indications, pathophysiology and ideal closure techniques remain to be fully clarified and investigated before considering PFO closure a routine procedure.