Patent foramen ovale (PFO) is the new generation hole in the heart for 21st century cardiologist. Present in about 20% of population , would correspond to 140 crore “man holes” as on 2012 in this planet. PFOs are embryological remnants across the inter atrial septum.
These minute holes measuring few mm are largely a benign finding .In the recent decades , it is being increasingly debated these holes may not be innocent after all .Extensive use of echocardiography in recent times has contributed to the awareness as well as anxiety.
Evidence is mounting linking PFO to
- Migraine,
- Stroke and
- Peripheral embolism.
While the above observation may be true , the fact that >100 crore people have this entity , raises a serious question , as labeling all of them as heart disease will create chaos among the already health obsessed population .
So , the main purpose should be , to identify the high risk subsets* of PFO population .(This will be a <5 % at the most). People with PFO may carry a mental stigma because it is referred to as a hole in the heart by the general public .For many the sense of living with a hole in heart is often more damaging than the hole itself ! (Incidentally , many develop migraine only after reporting about this hole !)In a strict sense PFO is not a hole , rather it is a communication it may be tunnel or slit like .It is argued physician should avoid calling PFO as a hole .
*What is a significant PFO ?
- Large PFOs >5mm
- PFOs that shunt blood
- PFOs with septal aneurysms
- PFOs with documented stroke or embolism
- PFOs with atrial chiary network
- PFO in persons with systemic pro-coagulant states (Except probably in pregnancy )
Final message
PFO is a common residual congenital atrial septal anomaly . Usually benign . One can live with it perfect harmony. Only occasional patients are at risk.
So the prime job of cardiologists is to not diagnose and create panic about this entity. rather reassure them (Is it better do not reveal to them if it is found incidentally ? Patient empowerment group would call this a foul ! I do not support blind empowerment )
At the same time our main aim is to identify the high risk subsets who are prone for events.
Closure of PFO with device is required in a fraction . (*By the way , if PFO is really dangerous , why It is never an indication for surgical closure ? )
Reference
Your search for best information on PFO would end here . Here is a land mark article in JACC by Hara also contributed by Renu Virmani . A US Japan combines initiative : A must read by every cardiologists
http://content.onlinejacc.org/cgi/reprint/46/9/1768.pdf
http://www.anesthesia-analgesia.org/content/93/5/1137.full
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Dr.S.Venkatesan MD 