Patent Foramen Ovale in Childhood: Hidden Gateway to Microembolisms and Silent Neuroinflammation

Abstract

Patent Foramen Ovale (PFO) is a cardiac anomaly remaining from fetal circulation. While often asymptomatic, it can be associated with significant neurological and cardiovascular conditions such as cryptogenic stroke, hypoxemia, and migraines with aura. This study aimed to investigate the implications of PFO diagnosed in childhood, exploring its potential lifelong complications and evaluating the impact of therapeutic interventions, such as percutaneous closure, in preventing adverse outcomes. Through a systematic review of qualitative literature, articles published between 2014 and 2024 in reputable databases such as PubMed were analyzed. Keywords included terms related to cryptogenic stroke, hypoxemia, neuroinflammation, and long-term outcomes, ensuring a comprehensive approach to the topic. Following rigorous screening, 50 studies were selected that consistently addressed PFO-related complications and available therapeutic options. The results indicate that although PFO is asymptomatic in most cases, it may contribute to neurological and cardiovascular events in specific patient subgroups, particularly those with genetic predispositions or associated conditions like thrombophilia. Percutaneous closure showed potential in reducing complications such as recurrent strokes and hypoxemia episodes in carefully evaluated patients. However, in pediatrics, data remain limited, highlighting the need for studies assessing the long-term safety and efficacy of the intervention. Furthermore, the study underscores the importance of personalized strategies that integrate early diagnosis, advanced technologies, predictive biomarkers, and continuous monitoring to enhance PFO management. These approaches can optimize the identification of at-risk individuals and enable more effective interventions, preventing late complications and improving clinical outcomes. While often considered an incidental finding, PFO can have significant lifelong health implications. This study reinforces the need for greater attention to the condition, especially in pediatric populations, and emphasizes the importance of specific guidelines based on robust evidence.