Patent Foramen Ovale in Pregnancy: A Call for Action

Patent foramen ovale (PFO) is a common anatomical variant that can promote paradoxical embolic events. As pregnancy and the postpartum period are responsible for a hypercoagulable state, the risk for paradoxical embolism might be increased in the presence of a PFO. An updated systematic review was performed to evaluate the available data regarding the risk of adverse pregnancy outcomes in women with reported PFO-related complications during pregnancy or postpartum. A comprehensive literature search was performed using MEDLINE, Scopus, and Web of Science electronic databases from their inception to April 2024. A total of 28 pregnant women diagnosed with PFO were included (mean age, 29.43 ± 5.48 years). The majority of the paradoxical embolic events occurred during pregnancy (60%) while 3 (11%) occurred during delivery and 8 (29%) postpartum. A significant proportion of paradoxical embolism comprised ischemic events (89%) including ischemic stroke (57%), transient ischemic attack (14%), acute myocardial infarction (7%), and branch retinal artery occlusion (11%). Three women (11%) suffered cardiopulmonary arrest due to an amniotic fluid embolism. Moreover, thrombus in transit appeared in 4 women (14%). Twelve women (42%) underwent transcatheter PFO closure procedure during the pregnancy, 4 (14%) in the postpartum, and 7 (25%) received only medical treatment. Limited data exist regarding optimal management of PFO in pregnant women. Further research is needed to develop refined guidelines and improve outcomes for this unique patient population, ensuring both maternal and fetal safety.