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Overview
Patent foramen ovale (PFO) is a small hole in the heart that should close at the time of birth. It remains open in approximately 1 in 4 people. Most are unaware of the condition because it rarely causes symptoms.
The foramen ovale is a very small opening in the wall (septum) that separates the 2 upper chambers of the heart. These chambers are called atria. This opening:
- Allows blood with oxygen to bypass the lungs while a fetus is growing in the uterus, since the lungs aren’t functional until birth.
- Closes at birth when a baby starts to breathe.
If the foramen ovale, or opening, doesn’t seal completely, it can “flap open” momentarily. This can happen when you:
- Sneeze or cough
- Strain during a bowel movement
- Hold a high note while singing
These activities create pressure in your chest that may force blood to flow directly through the foramen ovale.
Most people have no symptoms. Patent foramen ovale is often discovered during tests for other health problems.
Patent Foramen Ovale
Patent foramen ovale is an abnormal opening in the wall between the right and left atrium.
Patent Foramen Ovale
Patent foramen ovale is an abnormal opening in the wall between the right and left atrium.
Causes and Symptoms
It’s not clear what causes a PFO. Genetic factors may play a role. The condition is congenital, which means the defect is present at birth. Most people with a PFO don’t have symptoms.
Possible Complications
Unless other heart defects are also present, a PFO isn’t typically associated with complications. However, research has linked these conditions to PFO.
Stroke
Normally, blood from your heart flows to your lungs. However, when blood flows through a PFO and contains a clot, it can travel to the brain and cause a stroke.
Less often, a blood clot that has travelled across the PFO may enter a heart artery, causing a heart attack. Clots can also block blood flow to the kidneys and cause kidney damage. Most people with a PFO never have a problem with clots leading to stroke, heart attack, or kidney damage.
Migraine with aura
This type of migraine is more common in people with PFO. Migraines with aura may cause:
- Blind spots
- Flashes of light
- Tingling in the hand or face and other symptoms
Decompression sickness
Although rare, decompression sickness (the “bends”) can occur in scuba divers. Nitrogen gas bubbles may form in the:
- Joints, causing severe joint pain
- Respiratory system, causing chest pain and difficulty breathing
PFO should be considered in divers who have severe decompression sickness.
PFO may also be linked to hypoxemia (low blood oxygen), high-altitude sickness, and obstructive sleep apnea.
Diagnosis
PFO is usually found during imaging tests to:
- Investigate other heart conditions.
- Determine the cause of a stroke or migraine.
If you’ve had a stroke without a known cause, which is also called a cryptogenic stroke, we may test you for a PFO.
These imaging tests are used to assess heart conditions and strokes.
Transthoracic echocardiogram
We spread gel on your chest and place a small wand (transducer) against the skin over your heart. This creates a moving picture of the heart using sound waves. It shows the structure and function of your heart. There are different components of an echocardiogram, including:
- Color-flow Doppler. Using sound waves, this test creates a color picture of blood as it flows through your heart. We can see if blood flows from the right to left atrium, which suggests a PFO.
- Bubble contrast. We inject a saline solution containing tiny bubbles into an IV. As we monitor your heart on the screen, we look for bubbles moving into the right atrium. If a PFO is present, some of the bubbles from the right atrium will appear in the left atrium. If a PFO isn’t present, the bubbles break up in the lungs and don’t reach the left atrium.
During these tests we may ask you to cough or take a deep breath and hold it. This increases pressure in your chest, which increases the chances of detecting a PFO.
Transesophageal echocardiogram
In this type of ultrasound, the transducer is on the end of a thin, flexible tube called an endoscope. We guide it down your throat and into the esophagus, which lies very close to the heart. This gives a close-up view of the valves and chambers of your heart. It’s an ideal test if the images from the transthoracic echocardiogram aren’t diagnostic.
Treatment
The majority of PFOs never require treatment.
Currently, there’s not enough evidence to routinely recommend closure to prevent stroke or to treat migraines. However, research continues in this area, and we’ll assess your specific situation to determine the best treatment approach for you. There are studies showing benefit in closing the hole if you’ve had stroke of unclear cause (cryptogenic stroke) that’s thought to be related to a PFO.
We may recommend closing the hole with surgery or a minimally invasive procedure.
If you’re already having another type of heart surgery, we can close a PFO at the same time.
These are the treatment options for closing a PFO.
Catheter-based procedure
During this procedure we’ll:
- Insert a long, thin tube (catheter) into a vein, usually in your upper inner thigh, and guide it to the heart.
- Use echocardiogram imaging to guide a closure device into the hole. Heart tissue grows over it during the next 3 to 6 months and creates a permanent seal.
The procedure usually takes 2 to 4 hours. Complications are rare but may include an irregular heartbeat and blood vessel damage.
Open-heart surgery
We may stitch the foramen ovale closed during open-heart surgery to repair other, more serious heart problems. We may close the opening using robotic devices inserted into the chest through a small incision.
Possible complications of open-heart surgery include infection and bleeding. Catheter-based procedures have largely replaced the use of open-heart surgery to close a PFO.
Lifestyle Recommendations
PFO is generally not a harmful condition, although knowing you have it can cause anxiety. If you don’t have symptoms, it’s highly unlikely that you’ll need to restrict your activities.
It’s a good idea to talk to your doctor before activities that limit your oxygen intake, such as mountain climbing or scuba diving. PFO may put you at risk for high-altitude sickness and decompression sickness.