1122:
placed in the right femoral vein and guided into the right atrium. The catheter is guided through the atrial septal wall and one disc (left atrial) is opened and pulled into place. Once this occurs, the other disc (right atrial) is opened in place and the device is inserted into the septal wall. This type of PFO closure is more effective than drug or other medical therapies for decreasing the risk of future thromboembolism. The most common adverse effect of PFO device closure is new-onset atrial fibrillation. Other complications, all rare, include device migration, erosion and embolization and device thrombosis or formation of an inflammatory mass with risk for recurrent ischemic stroke.
345:, which often closes after a person's birth. This remnant opening is caused by the incomplete fusion of the septum primum and the septum secundum; in healthy hearts, this fusion form the fossa ovalis, a portion of the interatrial septum which corresponds to the location of the foramen ovale in the fetus. In medical use, the term "patent" means open or unobstructed. In about 25% of people, the foramen ovale does not close, leaving them with a PFO or at least with what some physicians classify as a "pro-PFO", which is a PFO that is normally closed, but can open under increased right atrial pressure. On echocardiography, shunting of blood may not be noted except when the patient coughs.
446:
186:
1114:
1098:
730:
119:-rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart; or the opposite, depending on whether the left or right atrium has the higher blood pressure. In the absence of other heart defects, the left atrium has the higher pressure. This can lead to lower-than-normal oxygen levels in the arterial blood that supplies the brain, organs, and tissues. However, an ASD may not produce noticeable signs or symptoms, especially if the defect is small. Also, in terms of health risks, people who have had a
718:
867:
is greater than left atrial). Because better visualization of the atria is achieved with transesophageal echocardiography, this test may be performed in individuals with a suspected ASD which is not visualized on transthoracic imaging. Newer techniques to visualize these defects involve intracardiac imaging with special catheters typically placed in the venous system and advanced to the level of the heart. This type of imaging is becoming more common and involves only mild sedation for the patient typically.
380:. In the case of PFO, a blood clot from the venous circulatory system is able to pass from the right atrium directly into the left atrium via the PFO, rather than being filtered by the lungs, and thereupon into systemic circulation toward the brain. Also multiple substances -including the prothrombotic agent serotonin- are shunted bypassing the lungs. PFO is common in patients with an atrial septal aneurysm (ASA), a much rarer condition, which is also linked to cryptogenic (i.e., of unknown cause) stroke.
1046:
anticoagulation in reducing stroke in this population, it is hypothesized that based on the embolic mechanism, that anticoagulation should be superior to antiplatelet therapy at reducing risk of recurrent stroke. A recent review of the literature supports this hypothesis recommending anticoagulation over the use of antiplatelet therapy in patients with PFO and cryptogenic stroke. However, more evidence is required comparing of PFO closure with anticoagulation or anticoagulation with antiplatelet therapy.
1033:
993:
334:
702:
169:. A layer of tissue called the septum primum acts as a valve over the foramen ovale during fetal development. After birth, the pressure in the right side of the heart drops as the lungs open and begin working, causing the foramen ovale to close entirely. In about 25% of adults, the foramen ovale does not entirely seal. In these cases, any elevation of the pressure in the pulmonary circulatory system (due to
3184:
43:
957:
939:
921:
524:
hypertension, which increases the pressures in the right side of the heart, leading to the reversal of the shunt into a right-to-left shunt. Reversal of the shunt occurs, and the blood flowing in the opposite direction through the ASD is called
Eisenmenger's syndrome, a rare and late complication of an ASD.
2589:
Kuijpers, Ton; Spencer, Frederick A; Siemieniuk, Reed A C; Vandvik, Per O; Otto, Catherine M; Lytvyn, Lyubov; Mir, Hassan; Jin, Albert Y; Manja, Veena; Karthikeyan, Ganesan; Hoendermis, Elke; Martin, Janet; Carballo, Sebastian; O'Donnell, Martin; Vartdal, Trond; Baxter, Christine; Patrick-Lake, Bray;
1067:
If pulmonary hypertension is present, the evaluation may include a right heart catheterization. This involves placing a catheter in the venous system of the heart and measuring pressures and oxygen saturations in the superior vena cava, inferior vena cava, right atrium, right ventricle, and pulmonary
1138:
Septal
Occluder (ASO) is commonly used to close ASDs. The ASO consists of two self-expandable round discs connected to each other with a 4-mm waist, made up of 0.004– to 0.005-inch Nitinol wire mesh filled with Dacron fabric. Implantation of the device is relatively easy. The prevalence of residual
850:
The right ventricle can be thought of as continuously overloaded because of the left-to-right shunt, producing a widely split S2. Because the atria are linked via the atrial septal defect, inspiration produces no net pressure change between them, and has no effect on the splitting of S2. Thus, S2 is
686:
If the ASD is left uncorrected, the pulmonary hypertension progresses and the pressure in the right side of the heart becomes greater than the left side of the heart. This reversal of the pressure gradient across the ASD causes the shunt to reverse – a right-to-left shunt. This phenomenon is known
508:
does not pass through the lungs. The only way to release the excess inert gases from the body is to pass the blood carrying the inert gases through the lungs to be exhaled. If some of the inert gas-laden blood passes through the PFO, it avoids the lungs and the inert gas is more likely to form large
1054:
Once someone is found to have an atrial septal defect, a determination of whether it should be corrected is typically made. If the atrial septal defect is causing the right ventricle to enlarge a secundum atrial septal defect should generally be closed. If the ASD is not causing problems the defect
1000:
Until recently, patients with PFO and cryptogenic stroke were treated with antiplatelet therapy only. Previous studies did not identify a clear benefit of PFO closure over antiplatelet therapy in reducing recurrent ischemic stroke. However, based on new evidence and systematic review in the field,
866:
If agitated saline is injected into a peripheral vein during echocardiography, small air bubbles can be seen on echocardiographic imaging. Bubbles traveling across an ASD may be seen either at rest or during a cough. (Bubbles only flow from right atrium to left atrium if the right atrial pressure
1063:
Prior to correction of an ASD, an evaluation is made of the severity of the individual's pulmonary hypertension (if present at all) and whether it is reversible (closure of an ASD may be recommended for prevention purposes, to avoid such a complication in the first place. Pulmonary hypertension is
636:
In unaffected individuals, the chambers of the left side of the heart are under higher pressure than the chambers of the right side because the left ventricle has to produce enough pressure to pump blood throughout the entire body, while the right ventricle needs only to produce enough pressure to
1121:
Percutaneous device closure involves the passage of a catheter into the heart through the femoral vein guided by fluoroscopy and echocardiography. An example of a percutaneous device is a device which has discs that can expand to a variety of diameters at the end of the catheter. The catheter is
906:
In addition to the PR prolongation, individuals with a primum ASD have a left axis deviation of the QRS complex, while those with a secundum ASD have a right axis deviation of the QRS complex. Individuals with a sinus venosus ASD exhibit a left axis deviation of the P wave (not the QRS complex).
523:
If a net flow of blood exists from the left atrium to the right atrium, called a left-to-right shunt, then an increase in the blood flow through the lungs happens. Initially, this increased blood flow is asymptomatic, but if it persists, the pulmonary blood vessels may stiffen, causing pulmonary
133:
is the presence of a net flow of blood through a defect, either from left to right or right to left. The amount of shunting present, if any, determines the hemodynamic significance of the ASD. A right-to-left-shunt results in venous blood entering the left side of the heart and into the arterial
1045:
Based on the most up to date evidence, PFO closure is more effective at reducing recurrent ischemic stroke when compared to medical therapy. In most of these studies, antiplatelet and anticoagulation were combined in the medical therapy arm. Although there is limited data on the effectiveness of
983:
Most patients with a PFO are asymptomatic and do not require any specific treatment. However, those who develop a stroke require further workup to identify the etiology. In those where a comprehensive evaluation is performed and an obvious etiology is not identified, they are defined as having a
828:). During respiratory inspiration, the negative intrathoracic pressure causes increased blood return into the right side of the heart. The increased blood volume in the right ventricle causes the pulmonic valve to stay open longer during ventricular systole. This causes a normal delay in the P
383:
PFO is more common in people with cryptogenic stroke than in those with a stroke of known cause. While PFO is present in 25% in the general population, the probability of someone having a PFO increases to about 40 to 50% in those who have had a cryptogenic stroke, and more so in those who have a
1075:
If the pulmonary arterial pressure is more than two-thirds of the systemic systolic pressure, a net left-to-right shunt should occur at least 1.5:1 or evidence of reversibility of the shunt when given pulmonary artery vasodilators prior to surgery. (If
Eisenmenger's physiology has set in, the
372:
carcinoid heart disease (mitral valve). No cause is established for a foramen ovale to remain open instead of closing, but heredity and genetics may play a role. In rats research showed a link to the amount of
Cryptosporidium infestation and the number of newborn rats that failed to close their
3080:
Singh, V; Badheka, AO; Patel, NJ; Chothani, A; Mehta, K; Arora, S; Patel, N; Deshmukh, A; Shah, N; Savani, GT; Rathod, A; Manvar, S (22 December 2014). "Influence of hospital volume on outcomes of percutaneous atrial septal defect and patent foramen ovale closure: A 10-years us perspective".
962:
960:
944:
942:
926:
924:
749:
648:, blood shunts from the left atrium to the right atrium. This extra blood from the left atrium may cause a volume overload of both the right atrium and the right ventricle. If untreated, this condition can result in enlargement of the right side of the heart and ultimately heart failure.
569:
Some recent research has suggested that a proportion of cases of migraine may be caused by PFO. While the exact mechanism remains unclear, closure of a PFO can reduce symptoms in certain cases. This remains controversial; 20% of the general population has a PFO, which for the most part, is
491:
Due to the communication between the atria that occurs in ASDs, disease entities or complications from the condition are possible. Patients with an uncorrected atrial septal defect may be at increased risk for developing a cardiac arrhythmia, as well as more frequent respiratory infections.
961:
943:
925:
1084:
has occurred, a significant risk of mortality exists regardless of the method of closure of the ASD. In individuals who have developed
Eisenmenger's syndrome, the pressure in the right ventricle has raised high enough to reverse the shunt in the atria. If the ASD is then closed, the
778:. Some individuals with an ASD have surgical correction of their ASD during childhood. The development of signs and symptoms due to an ASD are related to the size of the intracardiac shunt. Individuals with a larger shunt tend to present with symptoms at a younger age.
1079:
Surgical mortality due to closure of an ASD is lowest when the procedure is performed prior to the development of significant pulmonary hypertension. The lowest mortality rates are achieved in individuals with a pulmonary artery systolic pressure less than 40 mmHg. If
2657:
1991:"Migraine Intervention With STARFlex Technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache"
959:
941:
923:
870:
If the individual has adequate echocardiographic windows, use of the echocardiogram to measure the cardiac output of the left ventricle and the right ventricle independently is possible. In this way, the shunt fraction can be estimated using echocardiography.
2761:
Shah, Rahman; Nayyar, Mannu; Jovin, Ion S.; Rashid, Abdul; Bondy, Beatrix R.; Fan, Tai-Hwang M.; Flaherty, Michael P.; Rao, Sunil V. (9 January 2018). "Device
Closure Versus Medical Therapy Alone for Patent Foramen Ovale in Patients With Cryptogenic Stroke".
437:
A sinus venosus ASD that involves the superior vena cava makes up 2 to 3% of all interatrial communication. It is located at the junction of the superior vena cava and the right atrium. It is frequently associated with anomalous drainage of the right-sided
1151:
As a group, atrial septal defects are detected in one child per 1500 live births. PFOs are quite common (appearing in 10–20% of adults), but when asymptomatic go undiagnosed. ASDs make up 30 to 40% of all congenital heart diseases that are seen in adults.
651:
Any process that increases the pressure in the left ventricle can cause worsening of the left-to-right shunt. This includes hypertension, which increases the pressure that the left ventricle has to generate to open the aortic valve during ventricular
836:. During expiration, the positive intrathoracic pressure causes decreased blood return to the right side of the heart. The reduced volume in the right ventricle allows the pulmonic valve to close earlier at the end of ventricular systole, causing P
1125:
Percutaneous closure of an ASD is currently only indicated for the closure of secundum ASDs with a sufficient rim of tissue around the septal defect so that the closure device does not impinge upon the superior vena cava, inferior vena cava, or the
1142:
Percutaneous closure is the method of choice in most centres. Studies evaluating percutaneous ASD closure among pediatric and adult population show that this is relatively safer procedure and has better outcomes with increasing hospital volume.
456:
view: The apex is towards the right, the atria are to the left. ASD secundum seen as a discontinuation of the white band of the atrial septum. The enlarged right atrium is below. The enlarged pulmonary veins are seen entering the left atrium
298:
Most individuals with an uncorrected secundum ASD do not have significant symptoms through early adulthood. More than 70% develop symptoms by about 40 years of age. Symptoms are typically decreased exercise tolerance, easy fatigability,
895:). The prolongation of the PR interval is probably due to the enlargement of the atria common in ASDs and the increased distance due to the defect itself. Both of these can cause an increased distance of internodal conduction from the
574:
in migraine typically averages around 40%. The high frequency of these facts make finding statistically significant relationships between PFO and migraine difficult (i.e., the relationship may just be chance or coincidence). In a large
2379:"Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: a systematic review and network meta-analysis incorporating complementary external evidence"
2661:
2805:
De Rosa, Salvatore; Sievert, Horst; Sabatino, Jolanda; Polimeni, Alberto; Sorrentino, Sabato; Indolfi, Ciro (9 January 2018). "Percutaneous
Closure Versus Medical Treatment in Stroke Patients With Patent Foramen Ovale".
3320:
3305:
1988:
Dowson, Andrew; Mullen, MJ; Peatfield, R; Muir, K; Khan, AA; Wells, C; Lipscombe, SL; Rees, T; De
Giovanni, JV; Morrison, WL; Hildick-Smith, D; Elrington, G; Hillis, WS; Malik, IS; Rickards, A (18 March 2008).
668:) and forces the right ventricle to pump out more blood than the left ventricle. This constant overloading of the right side of the heart causes an overload of the entire pulmonary vasculature. Eventually,
1139:
defect is low. The disadvantages are a thick profile of the device and concern related to a large amount of nitinol (a nickel-titanium compound) in the device and consequent potential for nickel toxicity.
984:
cryptogenic stroke. The mechanism for stroke is such individuals is likely embolic due to paradoxical emboli, a left atrial appendage clot, a clot on the inter-atrial septum, or within the PFO tunnel.
1089:
that the right ventricle has to act against has suddenly increased. This may cause immediate right ventricular failure, since it may not be able to pump the blood against the pulmonary hypertension.
2161:
Bossert, T; Walther, T; Gummert, J; Hubald, R; Kostelka, M; Mohr, FW (October 2002). "Cardiac malformations associated with the Holt–Oram syndrome – report on a family and review of the literature".
243:
The six types of atrial septal defects are differentiated from each other by whether they involve other structures of the heart and how they are formed during the developmental process during early
3239:
Germonpre, Peter; Hastir, Francis; Dendale, Paul; Marroni, Alessandro; Nguyen, Anne-Florence; Balestra, Costantino (1 April 2005). "Evidence for increasing patency of the foramen ovale in divers".
165:
allows blood from the right atrium to enter the left atrium during fetal development. This opening allows blood to bypass the nonfunctional fetal lungs while the fetus obtains its oxygen from the
3188:
579:, the higher prevalence of PFO in migraine patients was confirmed, but migraine headache cessation was not more prevalent in the group of migraine patients who underwent closure of their PFOs.
1363:
958:
940:
922:
2483:
Søndergaard, Lars; Kasner, Scott E.; Rhodes, John F.; Andersen, Grethe; Iversen, Helle K.; Nielsen-Kudsk, Jens E.; Settergren, Magnus; Sjöstrand, Christina; Roine, Risto O. (2017-09-14).
1469:
Freixa X, Arzamendi D, Tzikas A, Noble S, Basmadjian A, Garceau P, Ibrahim R (2014). "Cardiac procedures to prevent stroke: patent foramen ovale closure/left atrial appendage occlusion".
540:. In an individual with ASD, these emboli can potentially enter the arterial system, which can cause any phenomenon attributed to acute loss of blood to a portion of the body, including
691:. Once right-to-left shunting occurs, a portion of the oxygen-poor blood gets shunted to the left side of the heart and ejected to the peripheral vascular system. This causes signs of
847:
occurs because the extra blood return during inspiration gets equalized between the left and right atria due to the communication that exists between the atria in individuals with ASD.
3037:
Bhatt, P; Patel, A; Kumar, V; Lekshminarayanan, A; Patel, V; Alapati, S (August 2018). "Impact of hospital volume on outcomes of percutaneous ASD/PFO closure in pediatric patients".
3277:
2434:
Mas, Jean-Louis; Derumeaux, Geneviève; Guillon, Benoît; Massardier, Evelyne; Hosseini, Hassan; Mechtouff, Laura; Arquizan, Caroline; Béjot, Yannick; Vuillier, Fabrice (2017-09-14).
478:
The interatrial septum can be divided into five septal zones. If the defect involves two or more of the septal zones, then the defect is termed a mixed atrial septal defect.
2377:
Mir, Hassan; Siemieniuk, Reed
Alexander C.; Ge, Long Cruz; Foroutan, Farid; Fralick, Michael; Syed, Talha; Lopes, Luciane Cruz; Kuijpers, Ton; Mas, Jean-Louis (2018-07-01).
3159:
Feldt R, Avasthey P, Yoshimasu F, Kurland L, Titus J (1971). "Incidence of congenital heart disease in children born to residents of
Olmsted County, Minnesota, 1950–1969".
891:
The ECG findings in atrial septal defect vary with the type of defect the individual has. Individuals with atrial septal defects may have a prolonged PR interval (a
801:. If the ASD causes a left-to-right shunt, the pulmonary vasculature in both lungs may appear dilated on chest X-ray, due to the increase in pulmonary blood flow.
466:
Common (or single) atrium is a failure of development of the embryologic components that contribute to the atrial septal complex. It is frequently associated with
101:; however, when this does not naturally close after birth it is referred to as a patent (open) foramen ovale (PFO). It is common in patients with a congenital
259:
is the most common type of atrial septal defect and comprises 6–10% of all congenital heart diseases. It involves a patent ostium secundum (that is, a patent
3199:
1069:
1405:
1068:
artery, and in the wedge position. Individuals with a pulmonary vascular resistance (PVR) less than 7 wood units show regression of symptoms (including
2592:"Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke? A clinical practice guideline"
3438:
2532:
Saver, Jeffrey L.; Carroll, John D.; Thaler, David E.; Smalling, Richard W.; MacDonald, Lee A.; Marks, David S.; Tirschwell, David L. (2017-09-14).
1689:
1367:
2033:
Vis, JC; Duffels, MG; Winter, MM; Weijerman, ME; Cobben, JM; Huisman, SA; Mulder, BJ (May 2009). "Down syndrome: a cardiovascular perspective".
2217:
2126:
Burd, L; Deal, E; Rios, R; Adickes, E; Wynne, J; Klug, MG (July–August 2007). "Congenital heart defects and fetal alcohol spectrum disorders".
1771:
601:– about 50% of individuals with Ebstein anomaly have an associated shunt between the right and left atria, either an atrial septal defect or a
3791:
3274:
2639:
1155:
The ostium secundum atrial septal defect accounts for 7% of all congenital heart lesions. This lesion shows a male:female ratio of 1:2.
729:
555:
This is known as a paradoxical embolus because the clot material paradoxically enters the arterial system instead of going to the lungs.
2994:
Bjørnstad P (2006). "Is interventional closure the current treatment of choice for selected patients with deficient atrial septation?".
3489:
1596:
1423:
Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, Felberg R, Herrmann H, Kar S, Landzberg M, Raizner A, Wechsler L (2012).
660:
which increases the stiffness of the left ventricle, thereby increasing the filling pressure of the left ventricle during ventricular
321:
While pulmonary hypertension is unusual before 20 years of age, it is seen in 50% of individuals above the age of 40. Progression to
1545:
Sagris, D; Georgiopoulos, G; Perlepe, K; Pateras, K; Korompoki, E; Makaritsis, K; Vemmos, K; Milionis, H; Ntaios, G (November 2019).
1171:
3494:
1105:
Surgical closure of an ASD involves opening up at least one atrium and closing the defect with a patch under direct visualization.
2851:"Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials"
1055:
may simply be checked every two or three years. Methods of closure of an ASD include surgical closure and percutaneous closure.
717:
3431:
679:. The right ventricle is forced to generate higher pressures to try to overcome the pulmonary hypertension. This may lead to
2113:
1673:
1634:
3124:
Kaplan S (1993). "Congenital heart disease in adolescents and adults. Natural and postoperative history across age groups".
1506:"Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study"
1250:
Leachman R, Cokkinos D, Cooley D (1976). "Association of ostium secundum atrial septal defects with mitral valve prolapse".
1072:). However, individuals with a PVR greater than 15 wood units have increased mortality associated with closure of the ASD.
1703:
17:
3822:
3339:
781:
Adults with an uncorrected ASD present with symptoms of dyspnea on exertion (shortness of breath with minimal exercise),
1879:
Saary M, Gray G (2001). "A review of the relationship between patent foramen ovale and type II decompression sickness".
1547:"Antithrombotic Treatment in Cryptogenic Stroke Patients With Patent Foramen Ovale: Systematic Review and Meta-Analysis"
863:, an atrial septal defect may be seen on color flow imaging as a jet of blood from the left atrium to the right atrium.
3567:
3526:
3484:
3222:
1208:
1001:
percutaneous PFO closure in addition to antiplatelet therapy is suggested for all who meet all the following criteria:
401:
236:
216:
208:
3817:
3424:
813:
in an adult with an ASD include those related directly to the intracardiac shunt and those that are secondary to the
414:. Ostium primum defects are less common than ostium secundum defects. This type of defect is usually associated with
3744:
426:
A sinus venosus ASD is a type of atrial septum defect in which the defect involves the venous inflow of either the
536:(clots in the veins) are quite common. Embolizations (dislodgement of thrombi) normally go to the lung and cause
3749:
3639:
564:
3559:
2068:
Cherry, C; DeBord, S; Moustapha-Nadler, N (June 2009). "Ebstein's anomaly: a complex congenital heart defect".
592:
411:
3634:
3501:
3472:
2278:"Preoperative secundum atrial septal defect with coexisting sinus node and atrioventricular node dysfunction"
2262:
185:
3464:
3193:
1023:
445:
189:
Schematic drawing showing the location of different types of ASD, the view is into an opened right atrium.
2949:"Inflammatory mass formation on a patent foramen ovale closure device seventeen years after implantation"
1076:
right-to-left shunt must be shown to be reversible with pulmonary artery vasodilators prior to surgery.)
701:
576:
644:
In the case of a large ASD (> 9 mm), which may result in a clinically remarkable left-to-right
1721:
Davia J, Cheitlin M, Bedynek J (1973). "Sinus venosus atrial septal defect: analysis of fifty cases".
3541:
3531:
3477:
1081:
911:
688:
624:
612:
518:
322:
287:
442:
into the right atrium (instead of the normal drainage of the pulmonary veins into the left atrium).
3661:
3629:
3350:
892:
814:
786:
782:
541:
315:
3786:
3656:
3447:
657:
621:– both the osteium secundum and osteum primum types of ASD are associated with Holt–Oram syndrome
86:
1113:
914:, which is so characteristic that if it is absent, the diagnosis of ASD should be reconsidered.
410:
is occasionally classified as an atrial septal defect, but it is more commonly classified as an
3609:
3588:
1097:
669:
618:
608:
365:
311:
170:
3390:
2102:
1836:
Lier H, Schroeder S, Hering R (2004). "Patent foramen ovale: an underrated risk for divers?".
1790:"Mixed atrial septal defect coexisting ostium secundum and sinus venosus atrial septal defect"
3796:
3699:
3689:
3508:
2256:
1342:
342:
283:
276:
264:
162:
139:
98:
1586:
3716:
3694:
3666:
3595:
1949:"Association of interatrial shunts and migraine headaches: impact of transcatheter closure"
1626:
880:
879:
A less invasive method for detecting a PFO or other ASDs than transesophagal ultrasound is
810:
775:
665:
602:
598:
500:
ASDs, and particularly PFOs, are a predisposing venous blood carrying inert gases, such as
377:
8:
3549:
3455:
3404:
3324:
2348:
1789:
1504:
Homma, Shunichi; Sacco, Ralph L; Di Tullio, Marco R; Sciacca, Robert R; Mohr, JP (2002).
1334:
798:
680:
467:
120:
1224:
3106:
3062:
3019:
2976:
2883:
2850:
2831:
2787:
2738:
2713:
2616:
2591:
2571:
2411:
2378:
2186:
1990:
1861:
1765:
1683:
1522:
1505:
1185:
653:
537:
453:
431:
427:
368:, Raynaud's phenomenon, hyperventilation syndrome, transient global amnesia (TGA), and
135:
112:
102:
67:
3333:
3329:
3137:
2007:
851:
split to the same degree during inspiration as expiration, and is said to be "fixed".
3651:
3361:
3256:
3218:
3168:
3141:
3098:
3054:
3011:
2980:
2968:
2948:
2929:
2888:
2870:
2823:
2779:
2743:
2714:"Secundum atrial septal defect in adults: a practical review and recent developments"
2621:
2563:
2555:
2514:
2506:
2465:
2457:
2416:
2398:
2299:
2237:
2229:
2178:
2143:
2139:
2109:
2085:
2050:
2046:
2012:
1970:
1929:
1888:
1865:
1853:
1811:
1738:
1734:
1669:
1630:
1568:
1527:
1486:
1446:
1311:
1267:
1263:
1204:
97:. Some flow is a normal condition both pre-birth and immediately post-birth via the
55:
3110:
3023:
2534:"Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke"
2190:
1388:
3781:
3776:
3401:
3248:
3133:
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3066:
3046:
3003:
2960:
2919:
2878:
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2835:
2815:
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2733:
2725:
2611:
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2545:
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2447:
2406:
2390:
2289:
2170:
2135:
2077:
2042:
2002:
1960:
1919:
1845:
1801:
1730:
1619:
1558:
1517:
1478:
1436:
1259:
860:
449:
260:
150:, the presence of bluish-colored skin, especially of the lips and under the nails.
3252:
2964:
883:
with bubble contrast. This method reveals the cerebral impact of the ASD or PFO.
3771:
3711:
3646:
3624:
3355:
3281:
2866:
2105:
1563:
1546:
1127:
1029:
A variety of PFO closure devices may be implanted via catheter-based procedures.
1019:
763:
591:– patients with Down syndrome have higher rates of ASDs, especially a particular
268:
130:
60:
2685:"RESPECT 10-Year Data Strengthens Case for PFO Closure After Cryptogenic Stroke"
2436:"Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke"
2394:
611:– about one in four patients with fetal alcohol syndrome has either an ASD or a
595:. As many as one half of Down syndrome patients have some type of septal defect.
153:
During development of the baby, the interatrial septum develops to separate the
2924:
2907:
2322:
2081:
1965:
1948:
1806:
1482:
1303:
1032:
1012:
996:
The Amplatzer Septal Occluder is a device specifically designed to close an ASD
571:
439:
361:
228:
90:
3366:
3314:
3050:
3007:
2729:
2658:"How is a Patent Foramen Ovale (PFO) Closed Using a Catheter-based Procedure?"
1649:
992:
664:. The left-to-right shunt increases the filling pressure of the right heart (
3811:
3739:
3583:
2874:
2684:
2559:
2510:
2485:"Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke"
2461:
2402:
2233:
1425:"Closure or medical therapy for cryptogenic stroke with patent foramen ovale"
645:
588:
415:
407:
385:
272:
2294:
2277:
2241:
675:
The pulmonary hypertension will cause the right ventricle to face increased
3761:
3706:
3684:
3416:
3260:
3102:
3058:
3015:
2972:
2933:
2892:
2827:
2783:
2747:
2625:
2567:
2518:
2469:
2420:
2182:
2147:
2089:
2054:
2016:
1974:
1933:
1892:
1857:
1815:
1572:
1531:
1490:
1450:
1315:
1135:
1131:
1015:(i.e., no evident source of stroke despite a comprehensive evaluation), and
771:
767:
389:
158:
111:
After PFO closure the atria normally are separated by a dividing wall, the
3172:
3145:
2550:
2533:
2501:
2484:
2452:
2435:
2303:
1849:
1742:
1441:
1424:
1064:
not always present in adults who are diagnosed with an ASD in adulthood).
968:
ASD with pulmonary embolism resulting in a right-to-left shunting of blood
950:
ASD with pulmonary embolism resulting in a right-to-left shunting of blood
932:
ASD with pulmonary embolism resulting in a right-to-left shunting of blood
570:
asymptomatic. About 20% of the female population has migraines, and the
333:
3754:
3385:
3217:(24th ed.). Philadelphia: Elsevier Saunders. pp. 270, 400–401.
2174:
1591:
1271:
790:
353:
300:
154:
3766:
3297:
3094:
2607:
627:– the presence of a congenital ASD along with acquired mitral stenosis
3396:
2819:
2775:
2032:
1086:
683:(dilatation and decreased systolic function of the right ventricle).
676:
549:
509:
bubbles in the arterial blood stream causing decompression sickness.
275:. About 10 to 20% of individuals with ostium secundum ASDs also have
263:). The secundum atrial septal defect usually arises from an enlarged
143:
2160:
1924:
1907:
789:(stroke). They may be noted on routine testing to have an abnormal
373:
foramen ovale. PFO is not treated in the absence of other symptoms.
1987:
1008:
821:
692:
661:
533:
505:
357:
304:
166:
147:
105:
2067:
1302:
Oduah, Mary-Tiffany A.; Sharma, Piyush; Brown, Kristen N. (2023),
748:
2590:
Scott, Joanie; Agoritsas, Thomas; Guyatt, Gordon (25 July 2018).
1908:"Patent foramen ovale: paradoxical embolism and paradoxical data"
1544:
900:
896:
752:
Abnormal chest X-ray as seen in a patient of atrial septal defect
376:
The mechanism by which a PFO may play a role in stroke is called
3344:
2588:
3309:
3036:
2482:
820:
In unaffected individuals, respiratory variations occur in the
758:
708:
545:
501:
349:
341:
A patent foramen ovale (PFO) is a remnant opening of the fetal
325:
occurs in 5 to 10% of individuals late in the disease process.
123:
116:
2804:
1755:
1203:(8th ed.). Philadelphia: Saunders/Elsevier. p. 384.
3238:
3158:
2433:
1616:
244:
174:
94:
2125:
2028:
2026:
1787:
1668:(8th ed.). New York: McGraw–Hill Medical. p. 357.
1947:
Azarbal B, Tobis J, Suh W, Chan V, Dao C, Gaster R (2005).
1400:
1398:
638:
126:
are more likely to have a PFO than the general population.
2947:
Ballet, Arne; Ballet, Brice; Deblier, Ivo (22 June 2019).
2531:
1503:
1468:
910:
A common finding in the ECG is the presence of incomplete
42:
3079:
2023:
1422:
794:
1395:
2908:"Transcatheter Device Closure of Atrial Septal Defects"
2376:
1758:
Echocardiographic diagnosis of congenital heart disease
1664:
Skelley, Tao Le, Vikas Bhushan, Nathan William (2012).
1788:
John, J; Abrol, S; Sadiq, A; Shani, J (Jul 26, 2011).
1249:
756:
Most individuals with a significant ASD are diagnosed
3200:
United States Department of Health and Human Services
2760:
2218:"Transcranial doppler monitoring. (letter to editor)"
1117:
Illustration depicting surgical device closure of ASD
310:
Complications of an uncorrected secundum ASD include
3287:
1720:
1101:
Illustration depicting surgical patch closure of ASD
874:
565:
Migraine surgery § Patent foramen ovale closure
552:, or even a distal extremity (i.e., finger or toe).
177:, etc.) can cause the foramen ovale to remain open.
2946:
2711:
1946:
1835:
843:
In individuals with an ASD, a fixed splitting of S
2712:Kuijpers, JM; Mulder, BJ; Bouma, BJ (April 2015).
1618:
282:An ostium secundum ASD accompanied by an acquired
2222:South Pacific Underwater Medicine Society Journal
1610:
1391:. Texas Heart Institute Heart Information Center.
1058:
3809:
3083:Catheterization and Cardiovascular Interventions
1301:
2676:
2215:
1310:, Treasure Island (FL): StatPearls Publishing,
2372:
2370:
2368:
1625:. Baltimore: Williams & Wilkins. pp.
1464:
1462:
1460:
115:. If this septum is defective or absent, then
3432:
1794:Journal of the American College of Cardiology
723:Atrial septal defect with left-to-right shunt
146:. This may result in the clinical finding of
3792:Anomalous aortic origin of a coronary artery
3446:
2848:
1688:: CS1 maint: multiple names: authors list (
1366:. Boston Children's Hospital. Archived from
1364:"Patent Foramen Ovale Symptoms & Causes"
384:stroke before the age of 55. Treatment with
2993:
2365:
2275:
2035:Journal of Intellectual Disability Research
1457:
1416:
1285:
1283:
1281:
735:Illustration depicting atrial septal defect
161:. However, a hole in the septum called the
3439:
3425:
2244:. Archived from the original on 2012-04-26
1770:: CS1 maint: location missing publisher (
1659:
1657:
1497:
817:that may be present in these individuals.
461:
392:medications in this group appear similar.
41:
3195:National Heart, Lung, and Blood Institute
2923:
2882:
2737:
2707:
2705:
2650:
2615:
2549:
2500:
2451:
2410:
2317:
2315:
2313:
2293:
2197:
2006:
1964:
1923:
1878:
1805:
1756:Valdes-Cruz, L. M.; Cayre, R. O. (1998).
1562:
1521:
1440:
978:
512:
495:
3206:
3123:
1704:"Endocardial Cushion Defect Information"
1617:Fix, James D.; Dudek, Ronald W. (1998).
1278:
1112:
1096:
1031:
1005:Age ≤ 60 years at onset of first stroke,
991:
747:
444:
332:
184:
50:Illustration of an atrial septal defect.
3247:(7). Elsevier:Science direct: 912–915.
3212:
2682:
2203:
2163:The Thoracic and Cardiovascular Surgeon
1905:
1783:
1781:
1663:
1654:
1289:
1225:"Ostium Secundum Atrial Septal Defects"
1049:
804:
593:type that involves the ventricular wall
328:
14:
3810:
2702:
2310:
1599:from the original on 28 September 2007
762:or in early childhood with the use of
527:
3420:
2905:
1304:"Anatomy, Thorax, Heart Fossa Ovalis"
1198:
1108:
2683:Brauser, Deborah (16 October 2015).
1778:
886:
257:ostium secundum atrial septal defect
2323:"UOTW #54 – Ultrasound of the Week"
1429:The New England Journal of Medicine
1092:
854:
822:splitting of the second heart sound
27:Human heart defect present at birth
24:
3527:Sinus venosus atrial septal defect
3485:Transposition of the great vessels
3241:The American Journal of Cardiology
3232:
2912:JACC: Cardiovascular Interventions
2849:Vaduganathan, Muthiah (May 2018).
2660:. Cleveland Clinic. Archived from
1523:10.1161/01.CIR.0000017498.88393.44
1471:The Canadian Journal of Cardiology
1172:"Atrial Septal Defect Information"
1040:
402:Ostium primum atrial septal defect
293:
250:
25:
3834:
3268:
2008:10.1161/CIRCULATIONAHA.107.727271
1666:First aid for the USMLE step 2 CK
875:Transcranial doppler bubble study
271:, or excessive absorption of the
89:in which blood flows between the
3187: This article incorporates
3182:
2855:The American Journal of Medicine
2140:10.1111/j.1747-0803.2007.00105.x
2076:(6): 1098–1110, quiz 1111–1114.
2047:10.1111/j.1365-2788.2009.01158.x
955:
937:
919:
728:
716:
700:
486:
421:
395:
3152:
3117:
3073:
3030:
2987:
2940:
2899:
2842:
2798:
2754:
2632:
2582:
2538:New England Journal of Medicine
2525:
2489:New England Journal of Medicine
2476:
2440:New England Journal of Medicine
2427:
2341:
2269:
2209:
2154:
2119:
2096:
2061:
1981:
1940:
1899:
1872:
1829:
1749:
1714:
1696:
1643:
1579:
1538:
1381:
1146:
1036:Amplatzer PFO Occluder in heart
481:
3560:Atrioventricular septal defect
2216:Glen, S.; J. Douglas. (1995).
1356:
1327:
1295:
1243:
1217:
1192:
1178:
1164:
1059:Evaluation prior to correction
987:
412:atrioventricular septal defect
13:
1:
3502:Persistent truncus arteriosus
3473:Double outlet right ventricle
3253:10.1016/j.amjcard.2004.12.026
3138:10.1016/S0733-8651(18)30137-1
2965:10.1080/00015385.2019.1630587
1158:
1024:bubble study (echocardiogram)
631:
3465:Aortopulmonary septal defect
2867:10.1016/j.amjmed.2017.11.027
1735:10.1016/0002-8703(73)90458-4
1587:"Atrial Septal Defect Types"
1564:10.1161/STROKEAHA.119.026512
1406:"Patent Foramen Ovale (PFO)"
1264:10.1016/0002-9149(76)90144-2
973:
743:
544:(stroke), infarction of the
138:without passing through the
7:
3039:World Journal of Pediatrics
2808:Annals of Internal Medicine
2764:Annals of Internal Medicine
2395:10.1136/bmjopen-2018-023761
1174:. The Mount Sinai Hospital.
577:randomized controlled trial
558:
267:, inadequate growth of the
10:
3839:
3823:Underwater diving medicine
2925:10.1016/j.jcin.2013.02.005
2276:Clark E, Kugler J (1982).
2082:10.1016/j.aorn.2009.03.003
1966:10.1016/j.jacc.2004.09.075
1807:10.1016/j.jacc.2010.11.077
1483:10.1016/j.cjca.2013.11.008
562:
516:
399:
217:lower sinus venosus defect
209:upper sinus venosus defect
3731:
3677:
3617:
3608:
3576:
3558:
3542:Ventricular septal defect
3540:
3517:
3463:
3454:
3376:
3291:
3051:10.1007/s12519-018-0120-3
3008:10.1017/S1047951105002027
2730:10.1007/s12471-015-0663-z
2718:Netherlands Heart Journal
2261:: CS1 maint: unfit URL (
1018:PFO with a right-to-left
912:right bundle branch block
681:right ventricular failure
613:ventricular septal defect
582:
66:
54:
49:
40:
35:
3818:Congenital heart defects
3448:Congenital heart defects
3284:information for parents.
3215:Goldman's Cecil Medicine
2906:Moore, John (May 2013).
2128:Congenital Heart Disease
1708:The Mount Sinai Hospital
893:first-degree heart block
787:cerebrovascular accident
783:congestive heart failure
542:cerebrovascular accident
473:
452:of the heart, seen in a
316:congestive heart failure
180:
93:(upper chambers) of the
3787:Coronary artery anomaly
2295:10.1161/01.CIR.65.5.976
1881:Aviat Space Environ Med
1201:Robbins Basic Pathology
1011:-appearing cryptogenic
658:coronary artery disease
462:Common or single atrium
87:congenital heart defect
3610:Valvular heart disease
3589:Cyanotic heart disease
3532:Lutembacher's syndrome
3189:public domain material
2327:Ultrasound of the Week
2108:, First Edition 2014,
1389:"Patent Foramen Ovale"
1118:
1102:
1082:Eisenmenger's syndrome
1037:
997:
753:
689:Eisenmenger's syndrome
670:pulmonary hypertension
625:Lutembacher's syndrome
609:Fetal alcohol syndrome
519:Eisenmenger's syndrome
513:Eisenmenger's syndrome
496:Decompression sickness
458:
366:decompression sickness
338:
323:Eisenmenger's syndrome
312:pulmonary hypertension
288:Lutembacher's syndrome
240:
198:: superior vena cava;
171:pulmonary hypertension
3797:Ventricular inversion
3509:Aortopulmonary window
3478:Taussig–Bing syndrome
3213:Goldman, Lee (2011).
3207:Additional references
2551:10.1056/nejmoa1610057
2502:10.1056/nejmoa1707404
2453:10.1056/nejmoa1705915
1850:10.1055/s-2004-812652
1442:10.1056/NEJMoa1009639
1343:TheFreeDictionary.com
1199:Kumar, Vinay (2007).
1116:
1100:
1070:NYHA functional class
1035:
995:
751:
448:
336:
284:mitral valve stenosis
277:mitral valve prolapse
188:
140:pulmonary circulation
3596:Eisenmenger syndrome
3519:Atrial septal defect
3275:Atrial septal defect
2175:10.1055/s-2002-34573
1838:Dtsch Med Wochenschr
1050:Atrial septal defect
979:Patent foramen ovale
881:transcranial Doppler
805:Physical examination
776:physical examination
603:patent foramen ovale
378:paradoxical embolism
364:, cluster headache,
337:Patent foramen ovale
329:Patent foramen ovale
202:: inferior vena cava
173:, temporarily while
79:Atrial septal defect
36:Atrial septal defect
18:Patent foramen ovale
3550:Tetralogy of Fallot
3456:Heart septal defect
1345:. September 1, 2014
815:right heart failure
799:atrial fibrillation
528:Paradoxical embolus
468:heterotaxy syndrome
227:: defect involving
223:: secundum defect;
194:: right ventricle;
3377:External resources
3280:2013-05-11 at the
1339:Medical Dictionary
1292:, pp. 400–401
1119:
1109:Catheter procedure
1103:
1038:
998:
840:to occur earlier.
754:
637:pump blood to the
619:Holt–Oram syndrome
459:
450:Ultrasound picture
432:inferior vena cava
428:superior vena cava
339:
241:
113:interatrial septum
3805:
3804:
3727:
3726:
3667:Ebstein's anomaly
3604:
3603:
3414:
3413:
3095:10.1002/ccd.25794
2953:Acta Cardiologica
2608:10.1136/bmj.k2515
2544:(11): 1022–1032.
2495:(11): 1033–1042.
2446:(11): 1011–1021.
2114:978-93-5152-140-2
2001:(11): 1397–1404.
1953:J Am Coll Cardiol
1887:(12): 1113–1120.
1675:978-0-07-176137-6
1636:978-0-683-30272-1
1557:(11): 3135–3140.
1516:(22): 2625–2631.
1020:interatrial shunt
963:
945:
927:
887:Electrocardiogram
859:In transthoracic
811:physical findings
599:Ebstein's anomaly
348:PFO is linked to
76:
75:
30:Medical condition
16:(Redirected from
3830:
3782:Brugada syndrome
3777:Crisscross heart
3647:tricuspid valves
3625:pulmonary valves
3615:
3614:
3461:
3460:
3441:
3434:
3427:
3418:
3417:
3289:
3288:
3264:
3228:
3203:
3186:
3185:
3177:
3176:
3156:
3150:
3149:
3121:
3115:
3114:
3089:(6): 1073–1081.
3077:
3071:
3070:
3034:
3028:
3027:
2991:
2985:
2984:
2944:
2938:
2937:
2927:
2903:
2897:
2896:
2886:
2846:
2840:
2839:
2820:10.7326/M17-3033
2802:
2796:
2795:
2776:10.7326/M17-2679
2758:
2752:
2751:
2741:
2709:
2700:
2699:
2697:
2695:
2680:
2674:
2673:
2671:
2669:
2654:
2648:
2647:
2644:www.uptodate.com
2636:
2630:
2629:
2619:
2586:
2580:
2579:
2553:
2529:
2523:
2522:
2504:
2480:
2474:
2473:
2455:
2431:
2425:
2424:
2414:
2374:
2363:
2362:
2360:
2359:
2353:www.uptodate.com
2345:
2339:
2338:
2336:
2334:
2319:
2308:
2307:
2297:
2273:
2267:
2266:
2260:
2252:
2250:
2249:
2213:
2207:
2201:
2195:
2194:
2158:
2152:
2151:
2123:
2117:
2100:
2094:
2093:
2065:
2059:
2058:
2030:
2021:
2020:
2010:
1985:
1979:
1978:
1968:
1944:
1938:
1937:
1927:
1906:Adams H (2004).
1903:
1897:
1896:
1876:
1870:
1869:
1833:
1827:
1826:
1824:
1822:
1809:
1785:
1776:
1775:
1769:
1761:
1753:
1747:
1746:
1718:
1712:
1711:
1700:
1694:
1693:
1687:
1679:
1661:
1652:
1647:
1641:
1640:
1624:
1614:
1608:
1607:
1605:
1604:
1583:
1577:
1576:
1566:
1542:
1536:
1535:
1525:
1501:
1495:
1494:
1466:
1455:
1454:
1444:
1420:
1414:
1413:
1402:
1393:
1392:
1385:
1379:
1378:
1376:
1375:
1360:
1354:
1353:
1351:
1350:
1331:
1325:
1324:
1323:
1322:
1299:
1293:
1287:
1276:
1275:
1247:
1241:
1240:
1238:
1236:
1221:
1215:
1214:
1196:
1190:
1189:
1182:
1176:
1175:
1168:
1093:Surgical closure
965:
964:
947:
946:
929:
928:
861:echocardiography
855:Echocardiography
732:
720:
711:of about 35 days
704:
538:pulmonary emboli
406:A defect in the
261:foramen secundum
45:
33:
32:
21:
3838:
3837:
3833:
3832:
3831:
3829:
3828:
3827:
3808:
3807:
3806:
3801:
3772:Cor triatriatum
3738:Underdeveloped
3723:
3673:
3600:
3572:
3554:
3536:
3513:
3450:
3445:
3415:
3410:
3409:
3372:
3371:
3300:
3282:Wayback Machine
3271:
3235:
3233:Further reading
3225:
3209:
3192:
3183:
3180:
3167:(12): 794–799.
3157:
3153:
3122:
3118:
3078:
3074:
3035:
3031:
2992:
2988:
2945:
2941:
2904:
2900:
2847:
2843:
2803:
2799:
2759:
2755:
2710:
2703:
2693:
2691:
2681:
2677:
2667:
2665:
2664:on 29 July 2016
2656:
2655:
2651:
2638:
2637:
2633:
2587:
2583:
2530:
2526:
2481:
2477:
2432:
2428:
2375:
2366:
2357:
2355:
2347:
2346:
2342:
2332:
2330:
2321:
2320:
2311:
2274:
2270:
2254:
2253:
2247:
2245:
2214:
2210:
2202:
2198:
2159:
2155:
2124:
2120:
2106:Jaypee Brothers
2101:
2097:
2066:
2062:
2031:
2024:
1986:
1982:
1945:
1941:
1925:10.4065/79.1.15
1904:
1900:
1877:
1873:
1834:
1830:
1820:
1818:
1786:
1779:
1763:
1762:
1760:. Philadelphia.
1754:
1750:
1719:
1715:
1702:
1701:
1697:
1681:
1680:
1676:
1662:
1655:
1648:
1644:
1637:
1615:
1611:
1602:
1600:
1585:
1584:
1580:
1543:
1539:
1502:
1498:
1467:
1458:
1435:(11): 991–999.
1421:
1417:
1404:
1403:
1396:
1387:
1386:
1382:
1373:
1371:
1362:
1361:
1357:
1348:
1346:
1333:
1332:
1328:
1320:
1318:
1300:
1296:
1288:
1279:
1248:
1244:
1234:
1232:
1223:
1222:
1218:
1211:
1197:
1193:
1184:
1183:
1179:
1170:
1169:
1165:
1161:
1149:
1111:
1095:
1061:
1052:
1043:
1041:Medical therapy
1013:ischemic stroke
990:
981:
976:
969:
966:
956:
951:
948:
938:
933:
930:
920:
889:
877:
857:
846:
839:
835:
831:
827:
807:
793:or an abnormal
764:ultrasonography
746:
740:
736:
733:
724:
721:
712:
707:Heart of human
705:
634:
585:
567:
561:
530:
521:
515:
498:
489:
484:
476:
464:
440:pulmonary veins
424:
404:
398:
331:
296:
294:Natural history
269:septum secundum
253:
251:Ostium secundum
203:
190:
183:
61:Cardiac surgery
31:
28:
23:
22:
15:
12:
11:
5:
3836:
3826:
3825:
3820:
3803:
3802:
3800:
3799:
3794:
3789:
3784:
3779:
3774:
3769:
3764:
3759:
3758:
3757:
3752:
3747:
3740:heart chambers
3735:
3733:
3729:
3728:
3725:
3724:
3722:
3721:
3720:
3719:
3714:
3704:
3703:
3702:
3697:
3692:
3681:
3679:
3675:
3674:
3672:
3671:
3670:
3669:
3664:
3659:
3654:
3644:
3643:
3642:
3637:
3632:
3621:
3619:
3612:
3606:
3605:
3602:
3601:
3599:
3598:
3593:
3592:
3591:
3580:
3578:
3574:
3573:
3571:
3570:
3564:
3562:
3556:
3555:
3553:
3552:
3546:
3544:
3538:
3537:
3535:
3534:
3529:
3523:
3521:
3515:
3514:
3512:
3511:
3505:
3504:
3499:
3498:
3497:
3492:
3482:
3481:
3480:
3469:
3467:
3458:
3452:
3451:
3444:
3443:
3436:
3429:
3421:
3412:
3411:
3408:
3407:
3405:article/894813
3393:
3381:
3380:
3378:
3374:
3373:
3370:
3369:
3358:
3347:
3336:
3317:
3301:
3296:
3295:
3293:
3292:Classification
3286:
3285:
3270:
3269:External links
3267:
3266:
3265:
3234:
3231:
3230:
3229:
3224:978-1437727883
3223:
3208:
3205:
3179:
3178:
3161:Mayo Clin Proc
3151:
3132:(4): 543–556.
3116:
3072:
3045:(4): 364–372.
3029:
2986:
2959:(6): 563–564.
2939:
2918:(5): 433–442.
2898:
2861:(5): 575–577.
2841:
2814:(5): 343–350.
2797:
2770:(5): 335–342.
2753:
2724:(4): 205–211.
2701:
2675:
2649:
2631:
2581:
2524:
2475:
2426:
2389:(7): e023761.
2364:
2340:
2329:. 30 July 2015
2309:
2288:(5): 976–980.
2268:
2208:
2196:
2169:(5): 312–314.
2153:
2134:(4): 250–255.
2118:
2095:
2060:
2041:(5): 419–425.
2022:
1980:
1959:(4): 489–492.
1939:
1912:Mayo Clin Proc
1898:
1871:
1844:(1–2): 27–30.
1828:
1777:
1748:
1729:(2): 177–185.
1713:
1695:
1674:
1653:
1642:
1635:
1609:
1578:
1537:
1496:
1456:
1415:
1394:
1380:
1355:
1326:
1294:
1277:
1258:(2): 167–169.
1242:
1216:
1210:978-1416029731
1209:
1191:
1177:
1162:
1160:
1157:
1148:
1145:
1110:
1107:
1094:
1091:
1060:
1057:
1051:
1048:
1042:
1039:
1027:
1026:
1016:
1006:
989:
986:
980:
977:
975:
972:
971:
970:
967:
954:
952:
949:
936:
934:
931:
918:
888:
885:
876:
873:
856:
853:
844:
837:
833:
832:component of S
829:
825:
806:
803:
745:
742:
738:
737:
734:
727:
725:
722:
715:
713:
706:
699:
633:
630:
629:
628:
622:
616:
606:
596:
584:
581:
572:placebo effect
563:Main article:
560:
557:
529:
526:
517:Main article:
514:
511:
497:
494:
488:
485:
483:
480:
475:
472:
463:
460:
423:
420:
400:Main article:
397:
394:
330:
327:
314:, right-sided
295:
292:
252:
249:
229:coronary sinus
182:
179:
74:
73:
70:
64:
63:
58:
52:
51:
47:
46:
38:
37:
29:
26:
9:
6:
4:
3:
2:
3835:
3824:
3821:
3819:
3816:
3815:
3813:
3798:
3795:
3793:
3790:
3788:
3785:
3783:
3780:
3778:
3775:
3773:
3770:
3768:
3765:
3763:
3760:
3756:
3753:
3751:
3748:
3746:
3743:
3742:
3741:
3737:
3736:
3734:
3730:
3718:
3717:regurgitation
3715:
3713:
3710:
3709:
3708:
3707:mitral valves
3705:
3701:
3698:
3696:
3695:insufficiency
3693:
3691:
3688:
3687:
3686:
3685:aortic valves
3683:
3682:
3680:
3676:
3668:
3665:
3663:
3660:
3658:
3657:regurgitation
3655:
3653:
3650:
3649:
3648:
3645:
3641:
3638:
3636:
3635:insufficiency
3633:
3631:
3628:
3627:
3626:
3623:
3622:
3620:
3616:
3613:
3611:
3607:
3597:
3594:
3590:
3587:
3586:
3585:
3584:Cardiac shunt
3582:
3581:
3579:
3575:
3569:
3568:Ostium primum
3566:
3565:
3563:
3561:
3557:
3551:
3548:
3547:
3545:
3543:
3539:
3533:
3530:
3528:
3525:
3524:
3522:
3520:
3516:
3510:
3507:
3506:
3503:
3500:
3496:
3493:
3491:
3488:
3487:
3486:
3483:
3479:
3476:
3475:
3474:
3471:
3470:
3468:
3466:
3462:
3459:
3457:
3453:
3449:
3442:
3437:
3435:
3430:
3428:
3423:
3422:
3419:
3406:
3403:
3399:
3398:
3394:
3392:
3388:
3387:
3383:
3382:
3379:
3375:
3368:
3364:
3363:
3359:
3357:
3353:
3352:
3348:
3346:
3342:
3341:
3337:
3335:
3331:
3327:
3326:
3322:
3318:
3316:
3312:
3311:
3307:
3303:
3302:
3299:
3294:
3290:
3283:
3279:
3276:
3273:
3272:
3262:
3258:
3254:
3250:
3246:
3242:
3237:
3236:
3226:
3220:
3216:
3211:
3210:
3204:
3201:
3197:
3196:
3190:
3174:
3170:
3166:
3162:
3155:
3147:
3143:
3139:
3135:
3131:
3127:
3120:
3112:
3108:
3104:
3100:
3096:
3092:
3088:
3084:
3076:
3068:
3064:
3060:
3056:
3052:
3048:
3044:
3040:
3033:
3025:
3021:
3017:
3013:
3009:
3005:
3001:
2997:
2996:Cardiol Young
2990:
2982:
2978:
2974:
2970:
2966:
2962:
2958:
2954:
2950:
2943:
2935:
2931:
2926:
2921:
2917:
2913:
2909:
2902:
2894:
2890:
2885:
2880:
2876:
2872:
2868:
2864:
2860:
2856:
2852:
2845:
2837:
2833:
2829:
2825:
2821:
2817:
2813:
2809:
2801:
2793:
2789:
2785:
2781:
2777:
2773:
2769:
2765:
2757:
2749:
2745:
2740:
2735:
2731:
2727:
2723:
2719:
2715:
2708:
2706:
2690:
2686:
2679:
2663:
2659:
2653:
2645:
2641:
2635:
2627:
2623:
2618:
2613:
2609:
2605:
2601:
2597:
2593:
2585:
2577:
2573:
2569:
2565:
2561:
2557:
2552:
2547:
2543:
2539:
2535:
2528:
2520:
2516:
2512:
2508:
2503:
2498:
2494:
2490:
2486:
2479:
2471:
2467:
2463:
2459:
2454:
2449:
2445:
2441:
2437:
2430:
2422:
2418:
2413:
2408:
2404:
2400:
2396:
2392:
2388:
2384:
2380:
2373:
2371:
2369:
2354:
2350:
2344:
2328:
2324:
2318:
2316:
2314:
2305:
2301:
2296:
2291:
2287:
2283:
2279:
2272:
2264:
2258:
2243:
2239:
2235:
2231:
2227:
2223:
2219:
2212:
2206:, p. 270
2205:
2200:
2192:
2188:
2184:
2180:
2176:
2172:
2168:
2164:
2157:
2149:
2145:
2141:
2137:
2133:
2129:
2122:
2115:
2111:
2107:
2104:
2099:
2091:
2087:
2083:
2079:
2075:
2071:
2064:
2056:
2052:
2048:
2044:
2040:
2036:
2029:
2027:
2018:
2014:
2009:
2004:
2000:
1996:
1992:
1984:
1976:
1972:
1967:
1962:
1958:
1954:
1950:
1943:
1935:
1931:
1926:
1921:
1917:
1913:
1909:
1902:
1894:
1890:
1886:
1882:
1875:
1867:
1863:
1859:
1855:
1851:
1847:
1843:
1839:
1832:
1817:
1813:
1808:
1803:
1799:
1795:
1791:
1784:
1782:
1773:
1767:
1759:
1752:
1744:
1740:
1736:
1732:
1728:
1724:
1717:
1709:
1705:
1699:
1691:
1685:
1677:
1671:
1667:
1660:
1658:
1651:
1646:
1638:
1632:
1628:
1623:
1622:
1613:
1598:
1594:
1593:
1588:
1582:
1574:
1570:
1565:
1560:
1556:
1552:
1548:
1541:
1533:
1529:
1524:
1519:
1515:
1511:
1507:
1500:
1492:
1488:
1484:
1480:
1476:
1472:
1465:
1463:
1461:
1452:
1448:
1443:
1438:
1434:
1430:
1426:
1419:
1411:
1410:www.heart.org
1407:
1401:
1399:
1390:
1384:
1370:on 2016-07-23
1369:
1365:
1359:
1344:
1340:
1336:
1330:
1317:
1313:
1309:
1305:
1298:
1291:
1286:
1284:
1282:
1273:
1269:
1265:
1261:
1257:
1253:
1246:
1230:
1226:
1220:
1212:
1206:
1202:
1195:
1187:
1181:
1173:
1167:
1163:
1156:
1153:
1144:
1140:
1137:
1134:valves. The
1133:
1129:
1123:
1115:
1106:
1099:
1090:
1088:
1083:
1077:
1073:
1071:
1065:
1056:
1047:
1034:
1030:
1025:
1021:
1017:
1014:
1010:
1007:
1004:
1003:
1002:
994:
985:
953:
935:
917:
916:
915:
913:
908:
904:
902:
898:
894:
884:
882:
872:
868:
864:
862:
852:
848:
841:
823:
818:
816:
812:
802:
800:
797:and may have
796:
792:
788:
784:
779:
777:
773:
769:
765:
761:
760:
750:
741:
731:
726:
719:
714:
710:
703:
698:
697:
696:
694:
690:
684:
682:
678:
673:
672:may develop.
671:
667:
663:
659:
655:
649:
647:
642:
640:
626:
623:
620:
617:
614:
610:
607:
604:
600:
597:
594:
590:
589:Down syndrome
587:
586:
580:
578:
573:
566:
556:
553:
551:
547:
543:
539:
535:
525:
520:
510:
507:
503:
493:
487:Complications
479:
471:
469:
455:
451:
447:
443:
441:
435:
433:
429:
422:Sinus venosus
419:
417:
416:Down syndrome
413:
409:
408:ostium primum
403:
396:Ostium primum
393:
391:
387:
386:anticoagulant
381:
379:
374:
371:
367:
363:
359:
355:
351:
346:
344:
343:foramen ovale
335:
326:
324:
319:
317:
313:
308:
306:
302:
291:
289:
285:
280:
278:
274:
273:septum primum
270:
266:
265:foramen ovale
262:
258:
248:
247:development.
246:
238:
237:primum defect
234:
230:
226:
222:
218:
214:
210:
206:
201:
197:
193:
187:
178:
176:
172:
168:
164:
163:foramen ovale
160:
156:
151:
149:
145:
141:
137:
132:
127:
125:
122:
118:
114:
109:
107:
104:
103:atrial septal
100:
99:foramen ovale
96:
92:
88:
84:
80:
71:
69:
65:
62:
59:
57:
53:
48:
44:
39:
34:
19:
3762:Dextrocardia
3577:Consequences
3518:
3395:
3384:
3360:
3349:
3338:
3319:
3304:
3244:
3240:
3214:
3194:
3181:
3164:
3160:
3154:
3129:
3126:Cardiol Clin
3125:
3119:
3086:
3082:
3075:
3042:
3038:
3032:
2999:
2995:
2989:
2956:
2952:
2942:
2915:
2911:
2901:
2858:
2854:
2844:
2811:
2807:
2800:
2767:
2763:
2756:
2721:
2717:
2692:. Retrieved
2688:
2678:
2666:. Retrieved
2662:the original
2652:
2643:
2634:
2599:
2595:
2584:
2541:
2537:
2527:
2492:
2488:
2478:
2443:
2439:
2429:
2386:
2382:
2356:. Retrieved
2352:
2343:
2331:. Retrieved
2326:
2285:
2281:
2271:
2257:cite journal
2246:. Retrieved
2225:
2221:
2211:
2204:Goldman 2011
2199:
2166:
2162:
2156:
2131:
2127:
2121:
2098:
2073:
2070:AORN Journal
2069:
2063:
2038:
2034:
1998:
1994:
1983:
1956:
1952:
1942:
1918:(1): 15–20.
1915:
1911:
1901:
1884:
1880:
1874:
1841:
1837:
1831:
1819:. Retrieved
1797:
1793:
1757:
1751:
1726:
1722:
1716:
1707:
1698:
1665:
1645:
1620:
1612:
1601:. Retrieved
1590:
1581:
1554:
1550:
1540:
1513:
1509:
1499:
1477:(1): 87–95.
1474:
1470:
1432:
1428:
1418:
1409:
1383:
1372:. Retrieved
1368:the original
1358:
1347:. Retrieved
1338:
1329:
1319:, retrieved
1307:
1297:
1290:Goldman 2011
1255:
1252:Am J Cardiol
1251:
1245:
1233:. Retrieved
1228:
1219:
1200:
1194:
1180:
1166:
1154:
1150:
1147:Epidemiology
1141:
1124:
1120:
1104:
1078:
1074:
1066:
1062:
1053:
1044:
1028:
1022:detected by
999:
982:
909:
905:
890:
878:
869:
865:
858:
849:
842:
819:
808:
780:
772:heart sounds
768:auscultation
757:
755:
739:
685:
674:
650:
643:
635:
568:
554:
531:
522:
499:
490:
482:Presentation
477:
465:
436:
425:
405:
390:antiplatelet
382:
375:
369:
347:
340:
320:
309:
301:palpitations
297:
281:
256:
254:
242:
232:
224:
220:
212:
204:
199:
195:
191:
152:
128:
110:
82:
78:
77:
72:asymptomatic
3755:Uhl anomaly
3386:MedlinePlus
3002:(1): 3–10.
2282:Circulation
1995:Circulation
1592:Mayo Clinic
1510:Circulation
988:PFO closure
791:chest X-ray
354:sleep apnea
159:right atria
136:circulation
121:cryptogenic
3812:Categories
3767:Levocardia
3362:DiseasesDB
2640:"UpToDate"
2358:2018-08-04
2349:"UpToDate"
2248:2008-04-06
1723:Am Heart J
1621:Embryology
1603:2007-10-14
1374:2016-07-19
1349:2015-03-26
1321:2023-11-15
1308:StatPearls
1235:5 November
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