Here , in this slide we have discussed about patent foramen ovale . Anatomy of patent foramen ovale , its embryology , its physiology and clinical implications .

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PATENT FORAMEN OVALE –
anatomy, physiology and clinical
implications.
Efforts by – Dr. Ashish Shankhdhar , MD
DNB Cardiology , NHI
New Delhi

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SEPTUM FORMATION IN COMMON ATRIUM
 At the end of 4th week sickle shaped crescent growth from the roof of common
atrium in to the lumen. This crest is first portion of septum primum .
 Septum primum grows downward like a curtain and a small opening left
between interventricular cushions and atrial cavity , is ostium primum.
 Now some superior and inferior endocardial cushions grow along the edge of
septum primum.
 Septum primum is closed but before that ostium secundum is opened.

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 Now with further development of atrium new crescent shape fold
appears known as septum secundum.
 It forms the left wall of smooth part of right atrium.
 Septum secundum never forms completely, thus foramen ovale
is therefore communication
 After birth this foramen ovale Is closed due to pressure
difference and is known as fovia ovalis.

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Clinical implications
 A patent foramen ovale (PFO) with right to left shunt (RLSh) is
an embrionary residue that has been linked with cryptogenic
stroke and peripheral ischemia.
 Pulmonary hypertension and entities like decompression illness,
migraine with aura or plathypnea – orthodeoxia have been found
to have higher prevalence of PFO with RLSh.
 Some dementia and unexplained syncope could also have some
relationship.

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 Paradoxical embolism, thrombosis of the foramen channel or
the atrial structure with subsequent embolism , transient
arrhythmias, pro-thrombotic states and vasoactive substance
passage have been proposed as physiopathalogic mechanism
involved.
 Contrast enhanced transesophageal echocardiography is the
standard reference diagnostic procedure but contrast enhanced
transcranial doppler is a good non invasive alternative
diagnostic tool that is highly sensitive and specific.

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