Diagnosing and treating Patent Foramen Ovale (PFO) from various manifestations in adults: case series

Abstract

Background. Patent foramen ovale (PFO) is a part of atrial septal defects (ASD) entities. While mostly asymptomatic, some adults with PFO will develop symptoms, from mild complaints such as migraine or palpitation to more debilitating complications such as syncope or cryptogenic stroke. Therefore, it is highly crucial that PFO be diagnosed and treated promptly. Echocardiography, trans-thoracal and or trans-esophageal, is the main diagnosis modality. For treatment, antiplatelet with or without anticoagulation, trans-catheter closure, and surgery are utilized in accordance with their indications. Case Presentation. We present four adult patients referred with various symptoms: vertigo, migraine, palpitation, and cryptogenic stroke. Three of them had no explicit risk factors for the cerebrovascular event, with one patient having a co-existing hypercoagulable state. Echocardiography revealed a positive bubble test, which meant that PFO was the primary etiology of those cases. We then treated each of them with transcatheter device closure, which improved their symptoms, before adding antiplatelet for six months. Conclusion. Proper diagnosis and prompt treatment of PFO are imperative in reducing complications. Echocardiography, mainly TEE, is the main diagnostic tool for PFO. Antithrombotic (with or without anticoagulant), minimally invasive procedure and surgery in some cases are the modalities available.