A patent foramen ovale (PFO) is a hole in the heart that didn't close the way it should after birth.
During fetal development, a small flap-like opening — the foramen ovale (foh-RAY-mun oh-VAY-lee) — is usually present between the right and left upper chambers of the heart. It normally closes during infancy. When the foramen ovale doesn't close, it's called a patent foramen ovale.
Although it's common to have a patent formen ovale, most people with the condition never know they have it. A patent foramen ovale is often discovered during tests for other problems. Learning that you have a patent foramen ovale is understandably worrisome, but most people never need treatment for this disorder.
Most people with a patent foramen ovale don't know they have it, because it's usually a hidden condition that doesn't create signs or symptoms.
A heart specialist (cardiologist) can detect a patent foramen ovale with one of the following tests:
An echocardiogram shows the structure and function of your heart. The standard form of this test is called a transthoracic echocardiogram.
With this test, a technician spreads gel on your chest and then presses a device called a transducer against the skin over the heart. The transducer emits high-pitched sound waves and records the sound wave echoes as they reflect off internal structures in the heart. A computer converts the echoes into moving images on a monitor. Variations of this procedure may be used to identify patent foramen ovale:
Color flow Doppler. When sound waves bounce off blood cells moving through your heart, they change pitch. These characteristic changes (Doppler signals) and computerized colorization of these signals can help your doctor examine the speed and direction of blood flow in your heart. If you have a patent foramen ovale, a color flow Doppler echocardiogram could detect the flow of blood between the right atrium and left atrium.
Saline contrast study (bubble study). With this approach, a sterile salt solution is shaken until tiny bubbles form and then is injected into a vein. The bubbles travel to the right side of your heart and appear on the echocardiogram. If there's no hole between the left atrium and right atrium, the bubbles will simply be filtered out in the lungs. If you have a patent foramen ovale, some bubbles will appear on the left side of the heart.
This test uses a small transducer on a tube inserted down the esophagus, the part of the digestive tract that runs from the throat to the stomach. Because the esophagus lies close to the heart, having the transducer placed there provides a detailed image of the heart and blood flow through the heart. The use of a transesophageal echocardiogram makes it easier to see a patent foramen ovale by either color-flow Doppler or a saline contrast study.
Most people with a patent foramen ovale don't need treatment. In certain circumstances, however, your doctor may recommend that you or your child have a procedure to close the patent foramen ovale.
Reasons for closure
If a patent foramen ovale is found when an echocardiogram is done for other reasons, a procedure to close the opening usually isn't performed. Procedures to close the opening in the heart may be used in the following circumstances:
If your child is undergoing surgery to correct a congenital heart defect and your child also has a patent foramen ovale, the surgeon may close the opening when making other repairs to the heart.
In adults having other types of heart surgery, a patent foramen ovale may be closed at the time of the operation.
Closure of a patent foramen ovale may be done to treat low blood oxygen levels linked to the patent foramen ovale.
Closure of a patent foramen ovale to prevent migraines isn't currently recommended. Closure of a patent formaen ovale to prevent a stroke remains controversial. Closure may be recommended for individuals with recurrent strokes despite medical therapy, when no other cause has been found.
Surgical and other procedures for closure Procedures to close patent foramen ovale include:
Device closure. Using cardiac catheterization, doctors can insert a device that plugs the patent foramen ovale. In this procedure, the device is on the end of a long flexible tube (catheter). 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. Although complications are uncommon with this procedure, a tear of the heart or blood vessels, dislodgement of the device, or the development of irregular heartbeats may occur.
Surgical repair. A surgeon can close the patent foramen ovale by opening up the heart and stitching shut the flap-like opening. This can sometimes be done with the use of robotic techniques and a very small incision. If you or your child is undergoing surgery to correct another heart problem, your doctor may recommend that you have the patent foramen ovale corrected surgically at the same time.
Medications can be used to try to reduce the risk of blood clots crossing a patent foramen ovale. Anti-platelet therapy such as aspirin or clopidogrel (Plavix) and other blood thinners, such as warfarin (Coumadin, Jantoven), dabigatran etexilate (Pradaxa) and rivaroxaban (Xarelto), may be helpful for people with a patent foramen ovale who've had a stroke. It's not clear whether medications or invasive procedures to close the defect are best for stroke prevention in people with a patent formen ovale, and studies are ongoing to answer this question.
If you know you have a patent foramen ovale, 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.