Incidence and Size of Patent Foramen Ovale During the First 10 Decades of Life: An Autopsy Study of 965 Normal Hearts

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The incidence and size of the patent foramen ovale were studied in 965 autopsy specimens of human hearts, which were from subjects who were evenly distributed by sex and age. Neither incidence nor size of the defect was significantly different between male and female subjects. The overall incidence was 27.3%, but it progressively declined with increasing age from 34.3% during the first three decades of life to 25.4% during the 4th through 8th decades and to 20.2% during the 9th and 10th decades. Among the 263 specimens that exhibited patency in our study, the foramen ovale ranged from 1 to 19 mm in maximal potential diameter (mean, 4.9 mm). In 98% of these cases, the foramen ovale was 1 to 10 mm in diameter. The size tended to increase with increasing age, from a mean of 3.4 mm in the first decade to 5.8 mm in the 10th decade of life.

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MATERIAL AND METHODS

Specimens of normal human hearts were procured from the tissue registry at our institution. For the study, hearts were considered normal if there was no clinical history or autopsy evidence of cardiovascular disease; accordingly, hearts were excluded if there was a history of hypertension or cardiomyopathy or if there was autopsy evidence of critical coronary atherosclerosis or functionally important valvular or congenital heart disease.

We obtained the most recently available autopsy specimens

RESULTS

The incidence of patent foramen ovale was 27.3% (263 of 965) for all age groups combined and 26.8% (127 of 473) for males and 27.6% (136 of 492) for females. No statistically significant difference was found in the incidence between males and females when the data were analyzed by decades. The incidence progressively declined with increasing age, however (Fig. 2). The foramen ovale was patent in approximately a third of persons 1 to 29 years of age, in about a fourth of those from 30 to 79

DISCUSSION

Among those features of the fetal circulation which may persist beyond the neonatal period, patency of the foramen ovale is the most common. Through this potential passageway, the right side of the heart may communicate directly with the left side of the heart, and thereby the pulmonary circulation may be bypassed.

Accordingly, any condition that results in higher right atrial pressure than left atrial pressure may produce a right-to-left shunt with systemic arterial desaturation and possible

ACKNOWLEDGMENT

We acknowledge Duane M. Ilstrup, Section of Medical Research Statistics, for the statistical analyses in this study.

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    Mayo Graduate School of Medicine, Rochester, Minnesota.

    Present address: Iowa City, Iowa.

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