I just double checked to make sure there were no new updates but I think they are really going overboard unless you are having symptoms. PFO is present in 25-30% of the population. Unless you are having very specific symptoms no treatment is indicated.
I am not a cardiologist just a general pediatrician but this one has me scratching my head a bit. Here is the official treatment summary for PFO.
SUMMARY AND RECOMMENDATIONSPatent foramen ovale (PFO) occurs in 25 to 30 percent of the general population. The prevalence of PFO is higher in patients with cryptogenic stroke, particularly those under age 55 years in whom PFO is more likely to play a causal role. (See
'Prevalence and pathophysiology' above.)
Most individuals with PFO are asymptomatic, although some have clinical manifestations such as cryptogenic stroke, air embolism, or platypnea-orthodeoxia. (See
'Clinical manifestations' above.)
Testing for PFO is indicated in patients with a cerebral ischemic event of uncertain origin or other clinical manifestations of PFO such as platypnea-orthodeoxia. (See
'Diagnosis' above.)
Identification of PFO in a patient with an embolic event does not prove a causal relationship. The evaluation of patients with PFO with an embolic event should include careful assessment of the likelihood that the PFO is causally related to the event, including identification of other potential causes of thromboembolism and stroke and of potential sources of venous thromboembolism. (See
'Diagnosis' above.)
Agitated saline contrast with ultrasound techniques (echocardiography or transcranial Doppler) enables shunt identification. (See
'Ultrasound techniques' above.)
Transeso****eal echocardiography (TEE) and transcranial Doppler methods have similar sensitivity and specificity for detection of right-to-left shunts, although echocardiography also permits evaluation of cardiac structure and function.
On agitated saline contrast echocardiography, appearance of at least three bubbles of contrast in the left heart within three beats after contrast opacification of the right atrium suggests the presence of intracardiac shunt.
TEE with contrast at rest, with cough, and following Valsalva is generally considered the most definitive diagnostic test for PFO.
Among those with cryptogenic stroke or other clinical indication for evaluation for PFO, we suggest starting with transthoracic echocardiography (TTE), with TEE performed if TTE is negative or nondiagnostic.
Since digital data compression may reduce the sensitivity of agitated saline contrast study, we suggest analog (videotape) recording and review of TTE and TEE contrast studies.
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