An Aneurysmal Interatrial Septum with a Patent Foramen Ovale and Multiple Fenestrations Closed by A Single Occluder Device
AbstractThe patent foramen ovale (PFO) usually is a very small potential opening in the atrial septum. Under the conditions of normal hemodynamics with higher left atrial than right atrial pressures, the septum primum is forced against the foramen by the higher left atrial pressure and there is no actual persistent opening through the foramen. However, with any, even transient, increase in right atrial pressure this flap or "valve" can be pushed away from the septum and forced open. This results in the shunting of blood and anything else in the right atrium from the right atrium to the left atrium. Often the "valve" of the foramen becomes redundant and develops an "aneurysm" of the atrial septum. A large, redundant septum primum can have several additional openings or "fenestrations" in it. The PFO is now can be treated by interventional percutaneous therapy. This case represents a 24-year-old male with an aneurysmal interatrial septum and patent foramen ovale associated with multiple fenestrations. The defects were closed by a single Amplatzer® septal occluder.
Kerut EK, Norfleet WT, Plotnick GD, Giles TD. Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol 2001;38(3):613-23.
Wu LA, Malouf JF, Dearani JA, Hagler DJ, Reeder GS, Petty GW, Khandheria BK. Patent foramen ovale in cryptogenic stroke: current understanding and management options. Arch Intern Med 2004;164(9):950-6.
Wilmshurst PT, Ellis BG, Jenkins BS. Paradoxical gas embolism in a scuba diver with an atrial septal defect. Br Med J (Clin Res Ed) 1986;293:1277.
Torti SR, Billinger M, Schwerzmann M, Vogel R, Zbinden R, Windecker S, Seiler C. Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale. Eur Heart J 2004;25(12):1014-20.
Cartoni D, De Castro S, Valente G, Costanzo C, Pelliccia A, Beni S, Di Angelantonio E, Papetti F, Vitali Serdoz L, Fedele F. Identification of professional scuba divers with patent foramen ovale at risk for decompression illness. Am J Cardiol 2004;94(2):270-3.
Cohnheim J. A general pathologic lecture. In: Thrombosis and Embolism. Berlin: Marzhouzer; 1877. p. 134-7.
Agostoni P, Gasparini G, Destro G. Acute myocardial infarction probably caused by paradoxical embolus in a pregnant woman. Heart 2004;90:e12.
Konstantinides S, Geibel A, Kasper W, Olschewski M, Blumel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation 1998;97:1946-51.
Meier B, Lock JE. Contemporary management of patent foramen ovale. Circulation 2003;107:5-9.