Abstract
Patent foramen ovale (PFO) is a common embryologic remnant that is usually clinically occult. Yet, a PFO may manifest clinically in two important ways, including serving as a conduit for emboli (bland, septic, or gas) and as a pathway for venous admixture or right-to-left shunt (as following pulmonary embolization or due to streaming of blood). The diagnosis of PFO is made by contrast-enhanced transesophageal echocardiography, usually using agitated saline injectate. Treatment involves closure of the PFO, which is indicated when clinical sequelae (e.g., paradoxic embolization and/or refractory hypoxemia due to right-to-left shunt) prompt correction. Options include surgical closure and deployment of a device from a catheter (e.g., a clam shelllike device that straddles the PFO).
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