The pathophysiology of patent foramen ovale and its related complications

IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American heart journal Pub Date : 2024-08-10 DOI:10.1016/j.ahj.2024.08.001
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Abstract

The foramen ovale plays a vital role in sustaining life in-utero; however, a patent foramen ovale (PFO) after birth has been associated with pathologic sequelae in the systemic circulation including stroke/transient ischemic attack (TIA), migraine, high altitude pulmonary edema, decompression illness, platypnea–orthodeoxia syndrome (POS) and worsened severity of obstructive sleep apnea. Importantly, each of these conditions is most commonly observed among specific age groups: migraine in the 20 to 40s, stroke/TIA in the 30-50s and POS in patients >50 years of age. The common and central pathophysiologic mechanism in each of these conditions is PFO-mediated shunting of blood and its contents from the right to the left atrium. PFO-associated pathologies can therefore be divided into (1) paradoxical systemic embolization and (2) right to left shunting (RLS) of blood through the PFO. Missing in the extensive literature on these clinical syndromes are mechanistic explanations for the occurrence of RLS, including timing and the volume of blood shunted, the impact of age on RLS, and the specific anatomical pathway that blood takes from the venous system to the left atrium. Visualization of the flow pattern graphically illustrates the underlying RLS and provides a greater understanding of the critical flow dynamics that determine the frequency, volume, and pathway of flow. In the present review, we describe the important role of foramen ovale in in-utero physiology, flow visualization in patients with PFO, as well as contributing factors that work in concert with PFO to result in the diverse pathophysiological sequelae.

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卵圆孔未闭及其相关并发症的病理生理学。
卵圆孔在胎儿时期对维持生命起着至关重要的作用;然而,出生后出现卵圆孔未闭 (PFO) 与全身循环的病理后遗症有关,包括中风/短暂性脑缺血发作 (TIA)、偏头痛、高原肺水肿、减压病、鸭嘴兽-缺氧综合征 (POS) 以及阻塞性睡眠呼吸暂停加重。重要的是,这些疾病中的每一种都在特定年龄组中最常见:偏头痛在 20-40 岁人群中最常见,中风/TIA 在 30-50 岁人群中最常见,而 POS 则在大于 50 岁的患者中最常见。这些病症的共同核心病理生理机制都是 PFO 介导的血液及其内容物从右心房向左心房的分流。因此,PFO 相关病症可分为:(1)矛盾性全身栓塞;(2)血液通过 PFO 从右向左分流(RLS)。在有关这些临床综合征的大量文献中,缺少对 RLS 发生机理的解释,包括分流的时间和血量、年龄对 RLS 的影响以及血液从静脉系统流向左心房的特定解剖路径。血流模式的可视化图解说明了 RLS 的基本情况,并使人们对决定血流频率、血量和路径的关键血流动力学有了更深入的了解。在本综述中,我们介绍了卵圆孔在胎儿期生理中的重要作用、PFO 患者的血流可视化,以及与 PFO 协同导致各种病理生理后遗症的诱因。
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来源期刊
American heart journal
American heart journal 医学-心血管系统
CiteScore
8.20
自引率
2.10%
发文量
214
审稿时长
38 days
期刊介绍: The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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