Patent Foramen Ovale and Atrial Septal Defect

Incomplete anatomical closure of the foramen ovale occurs in 27% of adults. It should not be considered as a pathological finding and usually needs no treatment. Nevertheless, PFO is a potential cause for paradoxical embolism. In case of a paradoxical embolism after exclusion of alternative sources of embolism therapeutic measures are indicated to prevent recurrent events. The options are medical therapy (antiplatelet therapy or anticoagulation) or transcatheter closure of the PFO. Three randomized clinical trials investigating PFO closure vs. medical therapy did not provide conclusive evidence for one treatment option. But there was a trend towards PFO closure. Although several studies have shown a potential association between migraine and PFO and observational studies suggest a significant improvement of migraine attacks after PFO closure, the randomized MIST-trial failed to confirm these findings. Therefore PFO closure in patients with migraine cannot be recommended. ASDs are the second most common type of congenital heart diseases in Germany. There are five different types depending on the location of the defect in the atrial septum. Most children with atrial septal defects are free of symptoms and diagnosis is made incidental during routine screening. Spontaneous closure may occur during the first years of life. If defects are undiagnosed, first symptoms (exercise intolerance, palpitations, paradoxical embolism) may occur in adulthood. Closure of an ASD is indicated in the presence of a hemodynamically significant shunt that causes enlargement of right heart structures or after paradoxical embolism. Treatment of choice for secundum defects is transcatheter closure. All other defects need surgical closure.