Is patent foramen ovale serious?

Patent foramen ovale is a problem that many girls have to face during pregnancy, because if this disease exists, the fetus will not develop normally and they will not be able to have their own baby. Girls should have a clear understanding of their physical condition after pregnancy, should not continue unhealthy living habits, and should go to the hospital in time for check-ups and prenatal examinations during pregnancy. So, is patent foramen ovale serious? How should it be handled?

1. Causes

The foramen ovale is formed when the embryo develops to the 6th or 7th week. The atrial septum gives off two septa one after another. The first septum is called the primary septum or the first septum, and the second septum is called the secondary septum or the second septum. The primary septum grows in a semilunar shape from the dorsal wall of the atrial midline, grows toward the atrioventricular canal and fuses with the endocardial cushions, leaving a small hole at the tail end of the atrioventricular septum, which is called the primary foramen. Before the primary foramen is closed, a hole is formed near the head end of the primary septum, called the secundum foramen, which is the normal channel for blood during the fetal period. At the same time, a sickle-shaped septum grows from the atrial wall on the right side of the first septum, called the secondary septum or the second septum. This septum does not continue to grow and stops halfway to separate the atria. The sickle-shaped depression is oval and is called the oval fossa. At the oval fossa, the primary septum and the secondary septum fail to adhere and fuse, leaving a small gap called the foramen ovale. When a newborn is born, with the first cry, the pressure in the left atrium increases, causing the left septum primum to adhere closely to the right septum secundum, resulting in functional closure, and anatomical closure is achieved within 1 year. If the foramen ovale of a child aged >3 years old still does not close, it is called patent foramen ovale.

2. Clinical manifestations

Patent foramen ovale is usually asymptomatic, with a difficult to hear murmur and normal electrocardiogram and chest X-ray. Therefore, it is not easy to find and is not taken seriously by people.

3. Inspection

1. Right cardiac catheterization

Right heart catheterization can directly enter the left atrium from the right atrium through the patent foramen ovale, confirming the presence of a patent foramen ovale. Color Doppler ultrasound is currently used to improve the accuracy of diagnosis.

2. Echocardiography

Transthoracic ultrasound and transesophageal ultrasound can detect patent foramen ovale with left-to-right shunt or right-to-left shunt. Ultrasound acoustic angiography can detect potential patent foramen ovale. Valsalva maneuver or cough test can increase the detection rate of patent foramen ovale to as high as 60% to 78%. The Valsalva maneuver or cough test can transiently increase right atrial pressure. At this time, injection of microbubble contrast can increase the detection rate of patent foramen ovale. The detection rate of patent foramen ovale by transesophageal ultrasound is three times that of transthoracic ultrasound.