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Patent Foramen Ovale (PFO)

The foramen ovale is a hole in the heart of every human fetus that allows blood to bypass the fetal lungs. When a newborn takes its first breath, the foramen ovale closes, and within a few months, it has sealed completely in about 75 percent of us.

When it doesn't close properly, it is called a patent foramen ovale (PFO). For the vast majority of the millions of people with a PFO, it is not a problem. In rare cases, a PFO can cause a significant amount of blood to bypass the lungs, resulting in low blood oxygen levels (hypoxemia). It can also cause blood clots which increases risk of stroke.

What happens once you have a patent foramen ovale (PFO)?

Generally, a PFO doesn't cause problems, but some studies have found the disorder is more common in people with certain conditions, such as migraines with aura (neurological symptoms or sensations, such as flashing lights or zigzag lines) or stroke caused by small blood clots in the heart that may travel to the brain through a PFO. The possible link between a PFO and a stroke or migraine is still unclear, and research is ongoing.

What causes patent foramen ovale (PFO)?

It's unclear what causes the foramen ovale to stay open in some people, though genetics may play a role.

What types of tests are used to diagnose patent foramen ovale (PFO)?

A heart doctor (cardiologist) may order one or more of the following tests to diagnose a PFO:

  • Echocardiogram: This test shows the anatomy, structure, and function of your heart. Sound waves directed at your heart produce video images of your heart in motion.

  • Color flow Doppler: When sound waves bounce off blood cells moving through your heart, they change pitch. These changes (Doppler signals) and computerized colorization of these signals can help your doctor see the speed and direction of blood flow in your heart.

  • Saline contrast study (bubble study): A sterile salt solution is shaken until tiny bubbles form and injected into a vein. The bubbles travel to the right side of your heart and appear on the echocardiogram. If there's no hole, the bubbles will be filtered out in the lungs. If you have a PFO, some bubbles will appear on the left side of the heart.

  • Transesophageal echocardiogram: In this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus).

What types of treatments and procedures are used to treat patent foramen ovale (PFO)?

Most people with a PFO don't need treatment. Procedures to close the PFO may be done in certain circumstances, such as to treat low blood oxygen levels. In some cases, doctors may recommend closure of the PFO in people who have had recurrent strokes and no other cause is found.

Surgical procedures to close a PFO include:

  • Device closure: Using cardiac catheterization, doctors can insert a device that plugs the PFO. The doctor inserts the device-tipped catheter into a vein in the groin and guides the device into place with the imaging assistance of an echocardiogram.

  • Surgical repair: A surgeon can close the PFO by opening up the heart and stitching shut the flap-like opening. This procedure can be conducted using a very small incision and may be performed using robotic techniques.

Anti-platelet medications can also be used to try to reduce the risk of blood clots crossing a PFO and causing a stroke.

What can I do to support my health when I have patent foramen ovale (PFO)?

If you know you have a PFO but don't have symptoms, you probably won't have any restrictions on your activities.

If you'll be traveling long distances, it's important to follow recommendations for preventing blood clots. If you're traveling by car, stop periodically and go for a short walk. On an airplane, be sure to stay well-hydrated and walk around whenever it's safe to do so.

Why choose Presbyterian for patent foremen ovale (PFO) treatment?

Presbyterian Heart and Vascular Care has the only pediatric and congenital cardiothoracic surgery team in New Mexico. Their team uses some of the most advanced techniques to perform this procedure. These techniques can improve recovery time, reduce complications and provide a quicker return to daily activities.