Some patients with a patent foramen ovale (PFO) may be asymptomatic while others may experience stroke or other major complications. Certain features can help to identify a patient foramen ovale that is associated with greater risk. A patient at high risk may benefit from an intervention to close the defect.
A high-risk PFO is associated with paradoxical embolism, stroke or other adverse event.
Features of a high-risk patent foramen ovale:
(1) large (>= 5 mm separation)
(2) severe contrast shunting (>= 50% of the left atrial area is filled with contrast material)
(3) presence of an atrial septal aneurysm
(4) presence of a Eustachian valve
(5) presence of a Chiari network (congenital remnant of the right valve of the sinus venosus)
Meier and Nietlispach suggested that the simultaneous presence of a pulmonary embolism and systemic embolus should be a clue to a high-risk PFO.
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