Patent Foramen Ovale (PFO) | William G. & Mary A. Ryan Center for Heart & Vascular Medicine | Loyola Medicine

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Patent Foramen Ovale (PFO)

Overview and Facts about Patent Foramen Ovale (PFO)

The foramen ovale is a small hole in the fetal heart, located between the right and left atria (upper chambers). Normally, the opening closes when the infant takes his or her first breath. A few months later, the hole is completely closed in around 75 percent of infants. When it doesn’t close and a hole remains in the heart, it is called a patent foramen ovale (PFO). This condition occurs in around 25 percent of the population, and many people with the condition are not aware of it. Most people do not need treatment for this disorder.

Signs and Symptoms of Patent Foramen Ovale (PFO)

Most people do not know they have a PFO as the condition doesn’t usually have signs or symptoms. However, the larger the hole, the more likely symptoms are to occur. Typically, a PFO is not investigated unless the patient experiences severe migraines, a stroke, or a transient ischemic attack (TIA).

Causes and Risk Factors of Patent Foramen Ovale (PFO)

What causes the foramen ovale to stay open in some infants is not known, though it may be in part due to genetics. Congenital heart conditions may increase the risk of this condition.

Tests and Diagnosis of Patent Foramen Ovale (PFO)

Your cardiologist may order an echocardiogram to see the structure and function of your heart. This test uses ultrasound to create images of the heart. Several different variations of the echocardiogram are used to diagnose a PFO.

  • Saline contrast study: The physician shakes a sterile saline solution until it is filled with tiny bubbles, then injects it into a vein. Once in the bloodstream, the bubbles are transported to the right atrium. This can be seen on the echocardiogram. If there is no PFO, the lungs will filter out the bubbles. If a PFO is present, the bubbles will begin to appear in the left atrium.  
  • Color flow Doppler: As sound waves rebound from blood cells passing through the heart, they change pitch. These changes are known as Doppler signals. An echocardiogram can highlight these changes in different colors on the computer screen, allowing the doctor to assess the direction and speed of blood flow through your heart.

Treatment and Care for Patent Foramen Ovale (PFO)

Most people with a PFO do not need treatment. However, in some cases, your physician may recommend that you undergo a surgical procedure to close the hole. Closure procedures include:

  • Surgical closure: For this procedure, the heart is opened and the PFO is stitched closed. The surgery can be performed with a very small incision.  
  • Device closure: Your physician can insert a device that plugs the PFO. This procedure is known as cardiac catheterization. A long, flexible tube with the device on the end is guided into a vein in the groin and up to the heart.  

Medications such as blood thinners may be prescribed to reduce the risk of stroke in patients with PFO.