What is Patent Foramen Ovale (PFO)?

The Foramen Ovale is a normal connection in the fetal heart that allows blood to bypass the lungs while the fetus is in-utero as oxygen is supplied to the fetus by the mother through the umbilical cord. After birth, this connection normally closes and is sealed, but in up to 20% of individuals, this connection does not completely seal and continues to allow blood to move from the right to the left side of the heart. For some individuals this opening is large enough to allow for blood clots to cross and travel to the brain to cause a stroke. In these individuals who have had a stroke or another embolic event, it may be appropriate to close this connection.

Signs and Symptoms

People with a patent foramen ovale usually do not have any symptoms. Regular checkups are important to screen for potential symptoms including:

• Breathlessness
• Stroke or TIA symptoms, such focal weakness or slurring speech
• Low oxygen levels

Diagnosis

Timely intervention is important for a patient with patent foramen ovale who has had a stroke to prevent future events. To diagnose a patent foramen ovale as the source of stroke we ask questions about your medical history and do a physical exam. We then use advanced technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves. 

Transesophageal Echocardiogram: A small transducer attached to the end of a tube inserted down the esophagus allows a closer look at intra-atrial septum than a regular echocardiogram does.

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.

Event monitor: This portable EKG device records the heart rate when a button is pressed. It can be worn for weeks or until symptoms occur.

Holter monitor: This portable EKG device continuously records the heart’s rhythms and is worn for 24 to 48 hours during normal activity.

Causes

Patent foramen ovale is failure of a normal structure to develop properly and a connection remains between the right and left sides of the heart.

Prevention

While there are no preventative measures for patent foramen ovale, there are ways you can help manage your patent foramen ovale:

Practice good heart health: Watch what you eat, exercise and avoid smoking.

Take your medications as prescribed: If you have high blood pressure or high cholesterol, be certain to take your prescribed medications as directed.

Prevent infections: See your doctor when you have a sore throat. Sore throats can mean strep and strep can develop into rheumatic fever, which weakens your aortic valve. Similarly, take good care of your teeth and gums. Infected gums can lead to heart infection.

Prognosis

Prognosis is usually good when a patent foremen ovale is treated.

Treatment and Recovery

Patent foramen ovale treatment depends upon the anatomy of the intra-atrial septum and size of the defect. Sometimes medication is prescribed to help manage your symptoms. Regular follow-up with your physician is an important part of your care.

Minimally Invasive Procedures

Minimally invasive techniques and procedures can be used to close a patent foramen ovale if deemed appropriate. Patent foramen ovale closure procedure is done in the cath lab using fluoroscopy and intracardiac echocardiography to help guide the procedure. A catheter is inserted into the leg vein and then used to cross the PFO. Through this catheter, a closure device is deployed to cover the defect and block blood flow. Two device types are the GORE-TEX® Cardioform Septal Occluder and the St. Jude Amplatzer PFO Occluder devices.

Surgery

Sometimes, due to the size of the defect or anatomy of the septum, closure must be done through traditional open surgery. During open surgery, the patent foramen ovale is fixed by placing a patch over the hole.

Recovery After Surgery

Recovery depends upon how your body heals and the type of surgery. After open surgery, you will be in the hospital for up to 10 days and it may be three to six months before you feel able to fully resume normal activities. After minimally invasive patent foremen ovale closure, you will be in the hospital for a day and it may be a week before full recovery.

Complications

If a patent foramen ovale is left untreated there can be a risk of recurrent stroke if not addressed by other methods such as anticoagulation.