Patent Foramen Ovale: Risk of Ischemic Stroke and ways to obtain the diagnosis

Authors

DOI:

https://doi.org/10.33448/rsd-v14i1.48086

Keywords:

Patent Oval Foramen; Ischemic Stroke; Diagnosis.

Abstract

Ischemic Stroke (Ischemic Stroke) is among the leading causes of death in the world. Recently, studies have linked ischemic stroke with Patent Foramen Ovale (PFO), as this relationship is common in young patients without risk factors. The foramen ovale is found in intrauterine life, with birth and the beginning of breathing, it physiologically closes. Non-closure allows the passage of emboli from the venous system to the arterial system via the right-to-left shunt, thus interrupting cerebral irrigation and reducing oxygen levels, which characterizes ischemic stroke. The study aims to describe the relationship between foramen ovale patent and ischemic stroke. Thus, this research was based on an analysis of articles selected from the VHL, PubMED, and Scielo databases, published between 2019 and 2024. The study's initial search resulted in 163 findings, with 138 excluded for reasons such as: duplicity, not using the appropriate language or not answering the guiding question. Therefore, 25 works were selected for the production of the study. Based on the findings, a set of elements were gathered and organized according to the PRISMA criteria, producing an integrative review based on the guiding question. The research made it possible to establish the link between FOP and ischemic stroke and understand the possible forms of diagnosis. As well as understanding the anatomy and forms of treatment to prevent ischemic stroke in patients with FOP, bringing fewer risks to the health of the population.

References

Aggarwal, V., Jayachandra, A., Aggarwal, N., & Ahmed, F. (2020). Study of transesophageal echocardiography in young patients (<40 years) with acute arterial ischemic stroke: A pilot study. Medical Journal Armed Forces India, 76(1), 47–50. https://doi.org/10.1016/j.mjafi.2018.07.006

Anima. (2014). Manual revisão bibliográfica sistemática integrativa: a pesquisa baseada em evidências. Grupo Anima.

https://biblioteca.cofen.gov.br/wp-content/uploads/2019/06/manual_revisao_bibliografica-sistematica-integrativa.pdf.

Baik, M., Shim, C. Y., Gwak, S., Kim, Y. D., Nam, H. S., Lee, H. S., Nam, C. M., & Heo, J. H. (2022). Patent Foramen Ovale and Risk of Recurrence in Stroke of Determined Etiology. Annals of Neurology, 92(4), 596–606. https://doi.org/10.1002/ana.26449

Bal, D., Ahmed Shaikh, A. I., Rayani, M., Aaron, S., Thompson, V. S., Jose, J., Krupa, J., Benjamin, R. N., Rajkumar, J. L., & Prabhakar, A. T. (2022). Transcranial Doppler Screening for Patent Foramen Ovale Closure in Cryptogenic Strokes in Young: A Single Center Experience from South India. The Journal of the Association of Physicians of India, 70(10), 11–12. https://doi.org/10.5005/japi-11001-0112

Becher, H., & Helfen, A. (2019). Contrast echocardiography: Compendium for clinical practice. Springer International Publishing.

https://doi.org/10.1007/978-3-030-15962-7

Benvenuti, F., Meucci, F., Vuolo, L., Nistri, R., Pracucci, G., Picchioni, A., Venturini, G., Stolcova, M., Failli, Y., Nencini, P., Di Mario, C., Sarti, C., & Heart and Brain Team Careggi University Hospital, Florence, Italy. (2022). Relation between the size of patent foramen ovale and the volume of acute cerebral ischemic lesion in young patients with cryptogenic ischemic stroke. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 43(1), 453–458. https://doi.org/10.1007/s10072-021-05330-y

Crossetti, M. G. M. (2012). Revisión integradora de la investigación en enfermería el rigor científico que se le exige. Rev. Gaúcha Enferm. 33(2), 8-9. 10)

Dattani, A., Safwan, K., Ansari, M., & Somani, R. (2022). Bi-atrial thrombus straddling a patent foramen ovale with bilateral embolization: A therapeutic challenge. Echocardiography (Mount Kisco, N.Y.), 39(1), 125–131. https://doi.org/10.1111/echo.15269

Deng, W., Yin, S., McMullin, D., Inglessis-Azuaje, I., Elmariah, S., Hung, J., Lo, E. H., Palacios, I. F., Buonanno, F. S., & Ning, M. (2020). Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence: A Prospective Cohort Study. Annals of Internal Medicine, 172(11), 717–725. https://doi.org/10.7326/M19-3583

Dimiati, H., Rasaki, R., & Haypheng, T. (2024). Cryptogenic stroke in a 5-year-old girl with patent foramen ovale: A rare case. Narra J, 4(1), e273. https://doi.org/10.52225/narra.v4i1.273

Di Stefano, V., Di Fulvio, M., Di Liberato, L., Onofrj, M., & De Angelis, M. V. (2020). Paradoxical embolism through a patent foramen ovale from central venous catheter thrombosis: A potential cause of stroke. Journal of the Neurological Sciences, 414, 116820. https://doi.org/10.1016/j.jns.2020.116820

Dusonchet, A., Varenne, O., Puscas, T., Saadi, M., Hagege, A., Calvet, D., Mas, J.-L., & Turc, G. (2024). Does Atrial Septal Anatomy Still Matter in the Etiological Evaluation of Ischemic Stroke Beyond the Age of 60? Journal of the American Heart Association, 13(4), e031684. https://doi.org/10.1161/JAHA.123.031684

Gomes, M. M. N., et al. (2021). Forame oval patente: Revisão de literatura. Brazilian Journal of Health Review. https://ojs.brazilianjournals.com.br/ojs/download.

Han, Y., Zhang, X., & Zhang, F. (2020). Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients. Journal of Cardiothoracic Surgery, 15(1). https://doi.org/10.1186/s13019-020-1042-4

Hołda, Mateusz K., & Koziej, M. (2020). Morphometric Features of Patent Foramen Ovale as a Risk Factor of Cerebrovascular Accidents: A Systematic Review and Meta-Analysis. Cerebrovascular Diseases, 49(1), 1–9. https://doi.org/10.1159/000506433

Khurana, D., Petluri, G., Kumar, M., Bahl, A., Kumar, A., Gairolla, J., & Prabhakar, S. (2022). Prevalence of Patent Foramen Ovale in North Indian Cryptogenic Young Strokes. Neurology India, 70(3), 1077–1082. https://doi.org/10.4103/0028-3886.349647

Lin, T.-Y., Fu, Y.-C., Jan, S.-L., & Lin, M.-C. (2022). Detecting Patent Foramen Ovale after Cryptogenic Stroke - A Single Center Experience in Taiwan. Acta Cardiologica Sinica, 38(3), 373–380. https://doi.org/10.6515/ACS.202205_38(3).20211228A

Lobo, P. G. G. A., et al. (2021). Epidemiologia do acidente vascular cerebral isquêmico no Brasil no ano de 2019: Uma análise sob a perspectiva da faixa etária. Brazilian Journal of Health Review. https://ojs.brazilianjournals.com.br/BJHR/article/view

Lou, J., Bao, Y., Lv, T., & Yang, Y. (2022). Computed Tomography for Detecting Patent Foramen Ovale: A Meta-Analysis. The Heart Surgery Forum, 25(6), E849–E853. https://doi.org/10.1532/hsf.5049

Lu, J., Li, J., Huang, H., & Ye, Q. (2022). Diagnostic Value of Micro-Bubble Transcranial Doppler Combined with Contrast Transthoracic Echocardiography in Cryptogenic Stroke Patients with Patent Foramen Ovale. Neurology India, 70(4), 1403–1403. https://doi.org/10.4103/0028-3886.355122

Mattos, P. C. (2015). Tipos de revisão de literatura. Unesp, 1-9. https://www.fca.unesp.br/Home/Biblioteca/tipos-de-evisao-de-literatura.pdf.

Mattosso, A. A. A., Sena, J. P., & Hotta, V. T. (2023). Papel do ecocardiograma na avaliação do septo interatrial e pesquisa de forame oval patente com fonte emboligênica. Sociedade Brasileira de Cardiologia. https://www.scielo.br/j/abc/a/6y8W64H6WpTD3Bdmmyggmfm/?format=pdf&lang=pt.

Nakashima, M., Takaya, Y., Nakayama, R., Tsuji, M., Akagi, T., Miki, T., Nakamura, K., & Yuasa, S. (2024). Morphological Features of Patent Foramen Ovale Compared Between Older and Young Patients With Cryptogenic Ischemic Stroke. Circulation Journal: Official Journal of the Japanese Circulation Society. https://doi.org/10.1253/circj.CJ-24-0313

Pommier, T., Lafont, A., Didier, R., Garnier, L., Duloquin, G., Meloux, A., Sagnard, A., Graber, M., Dogon, G., Laurent, G., Vergely, C., Béjot, Y., & Guenancia, C. (2024). Factors associated with patent foramen ovale-related stroke: SAFAS study. Revue Neurologique, 180(1-2), 33–41. https://doi.org/10.1016/j.neurol.2023.05.007

Rinkel, L. A., Bouma, B. J., Boekholdt, S. M., Beemsterboer, C. F. P., N H J Lobé, Beenen, L. F. M., Marquering, H. A., C B L M Majoie, Roos, M., A van Randen, Planken, R. N., & Coutinho, J. M. (2023). Detection of patent foramen ovale in patients with ischemic stroke on prospective ECG-gated cardiac CT compared to transthoracic echocardiography. https://doi.org/10.1007/s00415-023-11688-0

Schnieder, M., Chebbok, M., Didié, M., Wolf, F., Badr, M., Allam, I., Mathias Bähr, Gerd Hasenfuß, Liman, J., & Marco Robin Schroeter. (2021). Comparing the diagnostic value of Echocardiography In Stroke (CEIS) – results of a prospective observatory cohort study. BMC Neurology, 21(1). https://doi.org/10.1186/s12883-021-02136-5

Seong Ho Park, Jin Young Oh, Song, J.-K., Kwon, B.-M., Kim, B.-S., Jong Min Kim, Kang, D.-W., Chang, J., Ji Hyun Lee, & Kwon, S. U. (2020). Transcranial Doppler as a Screening Tool for High‐Risk Patent Foramen Ovale in Cryptogenic Stroke. 31(1), 165–170. https://doi.org/10.1111/jon.12783

Takaya, Y., Nakayama, R., Akagi, T., Yokohama, F., Miki, T., Nakagawa, K., Toh, N., & Ito, H. (2021). Importance of direct right-to-left shunt as high-risk patent foramen ovale associated with cryptogenic stroke. Echocardiography (Mount Kisco, N.Y.), 38(11), 1887–1892. https://doi.org/10.1111/echo.15234

Takemoto, K., Nakamura, M., & Atagi, K. (2021). Concomitant acute pulmonary embolism, myocardial infarction and ischemic stroke due to paradoxical embolism from a patent foramen ovale: a case report. Oxford Medical Case Reports, 2021(10). https://doi.org/10.1093/omcr/omab101

Tateishi, Y., Ueno, Y., Akira Tsujino, Kuriki, A., Kamiya, Y., Shimizu, T., Ryosuke Doijiri, Yamaguchi, E., Muneaki Kikuno, Shimada, Y., Takekawa, H., Koga, M., Ihara, M., Hirata, K., Hasegawa, Y., Toyoda, K., Hattori, N., & Urabe, T. (2021). Cardiac and Echocardiographic Markers in Cryptogenic Stroke with Incidental Patent Foramen Ovale. Journal of Stroke and Cerebrovascular Diseases, 30(8), 105892–105892. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105892

Vensão, L., & Santos, I. P. (2023). A importância da pesquisa de forame oval patente na investigação do acidente vascular cerebral isquêmico criptogênico. Brazilian Journal of Health Review. https://ojs.brazilianjournals.com.br/ojs/download

Vista do perfil do atendimento de pacientes com acidente vascular cerebral em um hospital filantrópico do sul de santa catarina e estudo de viabilidade para implantação da unidade de AVC. (2024). Acm.org.br. https://revista.acm.org.br/index.php/arquivos/article/view/432/334.

Zhang, H., Tang, H., Wu, F., Yu, C., Dong, Q., & Cao, W. (2022). A score of non-contrast transthoracic echocardiography to screen patent foramen ovale in patients with embolic stroke of undetermined source. BMC Neurology, 22(1). https://doi.org/10.1186/s12883-022-02565-w

Published

29/01/2025

How to Cite

VILELA, M. M. .; MENEGUETTI, R. .; MAINARDES, S. C. C. . Patent Foramen Ovale: Risk of Ischemic Stroke and ways to obtain the diagnosis. Research, Society and Development, [S. l.], v. 14, n. 1, p. e10014148086, 2025. DOI: 10.33448/rsd-v14i1.48086. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/48086. Acesso em: 15 jun. 2025.

Issue

Section

Health Sciences