Learn more about the causes and complications of this condition in which a hole in the heart doesn't close the way it should after birth.
A patent foramen ovale (PFO) is a hole in the heart that didn't close the way it should after birth. The hole is a small flaplike opening between the upper heart chambers. The upper chambers of the heart are called the atria.
As a baby grows in the womb, an opening called the foramen ovale (foh-RAY-mun oh-VAY-lee) sits between the upper heart chambers. It typically closes during infancy. When the foramen ovale doesn't close, it's called a patent foramen ovale.
Most people never need treatment for patent foramen ovale.
Patent foramen ovale occurs in about 1 in 4 people. Most people with the condition never know they have it. A patent foramen ovale is often discovered during tests for other health problems.
It's unclear why the foramen ovale stays open in some people. Genetics may play a role.
To understand more about patent foramen ovale, it may be helpful to know how the heart typically works.
The typical heart has four chambers that pump blood:
Because a baby in the womb isn't breathing, the lungs aren't working yet. That means there's no need to pump blood to the lungs. At this stage, blood goes around the baby's lungs. It uses the placenta and umbilical cord to move oxygen-rich blood from the mother to the baby's body.
In the baby's body, blood vessels connect to the umbilical cord. Oxygen-rich blood gets to the heart through the vein that drains blood from the body to the right upper heart chamber. This vein is called the inferior vena cava. The blood then goes across the foramen ovale and into the left upper heart chamber. Finally, the blood enters the left lower heart chamber, which pumps it throughout the body.
When a baby's lungs begin working, blood flow through the heart changes. Now the oxygen-rich blood comes from the lungs and enters the left upper heart chamber.
The pressure of the blood pumping through the heart usually forces the flap opening of the foramen ovale to close. In most people, the opening closes sometime during infancy.
A typical heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.
A patent foramen ovale, also called a PFO usually doesn't cause complications. Some people with a PFO may have other heart defects
Possible complications of patent foramen ovale may include:
Some studies have found that PFOs are more common in people with unexplained strokes and migraines with aura. But more research is needed. Usually, there are other reasons for these conditions. It's often just a coincidence a person also has a PFO.
Usually a patent foramen ovale is diagnosed when tests are done for another health concern. If your health care provider thinks you may have a PFO, imaging tests of the heart may be done.
If you have a patent foramen ovale and had a stroke, your provider may refer you to a doctor trained in brain and nervous system conditions. This type of provider is called a neurologist.
A test called an echocardiogram is used to diagnose a PFO. The test uses sound waves to create pictures of the beating heart. An echocardiogram shows the structure of the heart. It also shows how blood flows through the heart and heart valves.
This is a standard echocardiogram. It takes pictures of the heart from outside the body. The health care provider presses an ultrasound device, called a transducer, firmly against the skin over the heart area. The device records the sound wave echoes from the heart. A computer changes the echoes into moving images.
Variations of this procedure may be used to identify a patent foramen ovale, including:
Color-Doppler. When sound waves bounce off blood cells moving through the heart, they change pitch. These changes are called Doppler signals. They appear in different colors on the echocardiogram. This test can show the speed and direction of blood flow in the heart.
If you have a patent foramen ovale, this type of echocardiogram usually shows blood moving between the upper heart chambers.
Saline contrast study, also called a bubble study. During a standard echocardiogram, a sterile salt solution containing tiny bubbles is given by IV. The bubbles travel to the right side of the heart. They can be seen on an echocardiogram.
If there's no hole between the upper heart chambers, the bubbles are filtered out in the lungs. If you have a patent foramen ovale, some bubbles show up on the left side of the heart.
A patent foramen ovale may be difficult to confirm on a standard echocardiogram. Your provider may recommend this test to get a closer look at the heart.
A transesophageal echocardiogram takes pictures of the heart from inside the body. It's considered the most accurate way to diagnose a patent foramen ovale.
During this test, a flexible probe containing the ultrasound device is guided down the throat and into the tube connecting the mouth to the stomach. This tube is called the esophagus.
Most people with a patent foramen ovale don't need treatment. If a PFO is found when an echocardiogram is done for other reasons, a procedure to close the hole usually isn't done.
When treatment for a PFO is needed, it may include:
Your doctor may recommend medicines to try to reduce the risk of blood clots crossing a patent foramen ovale. Blood thinners may be helpful for some people with a patent foramen ovale who've had a stroke.
If you have a PFO and low blood oxygen levels or an unexplained stroke, you may need a procedure to close the hole.
Closure of a patent foramen ovale to prevent migraines isn't currently recommended as the first treatment. Closure of a patent foramen ovale to prevent recurrent stroke is only done after care providers trained in heart and nervous system disorders have said that the procedure will help you.
Procedures to close a patent foramen ovale include:
Device closure. In this procedure, the provider inserts a thin, flexible tube called a catheter into a blood vessel in the groin area. The catheter tip has a device to plug the PFO. The provider guides the equipment to the heart to close the opening.
Complications of device closure are uncommon. They may include a tear of the heart or blood vessels, movement of the device, or irregular heartbeats.
Surgical closure. In this heart surgery, the surgeon uses stitches to close the PFO. This surgery can be done using a very small incision. It may be done using robotic techniques.
If heart surgery is needed for another reason, your provider may recommend that this surgery be done at the same time.
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, take breaks and go for short walks. On an airplane, be sure to drink plenty of fluids and walk around whenever it's safe to do so.
After a patent foramen ovale has been diagnosed, you'll likely have a lot of questions for your health care providers. Some questions you may want to ask include: