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A patent foramen ovale (PFO) is a small opening between the two upper chambers of the heart, the right and the left atrium. Normally, a thin membranous wall made up of two connecting flaps separates these chambers. No blood can flow between them. If a PFO exists, a little blood can flow between the atria through the flaps. This flow is not normal.
The condition is most important because it raises the risk for stroke. Blood clots can travel from the right atrium to the left atrium and out to blood vessels of the body. If the clot blocks a blood vessel in the brain, it can cause a stroke. These clots can also damage other organs such as the heart or the kidneys.
Everyone has a PFO at birth. It is a normal part of the circulation of a fetus. But, in most infants, this small hole naturally closes very soon after birth. But in some cases, it does not. Having a patent foramen as an adult or older child is not normal. But it occurs in a large number of people. It may be slightly more common in younger adults compared with older adults. But it occurs in people of all ages. The size of the PFO can vary somewhat.
Before birth, a PFO is normal. In the fetus, blood high in oxygen travels from the right atrium, across the hole between the atria, and into the left atrium. From here, the blood higher in oxygen goes out to the lower left part of the heart and out to the rest of the body. After birth, the blood high in oxygen is already in the left atrium. So it doesn’t need blood from the right atrium. That’s why the foramen ovale normally closes soon after birth. Healthcare providers don’t know what causes the hole to stay open (patent) in some people instead of closing up.
Sometimes, PFO occurs along with other heart problems. One such condition is Ebstein anomaly. It’s when the valve between the upper and lower chambers on the right side of the heart doesn’t close properly. Blood can then flow backward.
Most of the time, PFO itself causes no symptoms. Sometimes symptoms do result from the complications of PFO, like stroke.
Your healthcare provider will ask about your past health and do a physical exam. He or she will also need tests to help make the diagnosis. These include:
Healthcare providers often pair these tests with a bubble study. In this test, the technician injects saline that has been shaken into a blood vessel. The resulting bubbles can be tracked through the heart with the above imaging tests.
Sometimes, a healthcare provider diagnoses a PFO based on tests that were needed to diagnose some other condition. Other times, the healthcare provider may be looking for a PFO. That might happen, for example, if he or she is looking for possible causes of a stroke.
In these cases, treatment for PFOs varies. In some cases, your healthcare provider may still choose not to treat the PFO. Other options include:
Ask your healthcare provider what treatment plan is best for you.
Stroke is the major potential complication of PFO. People who have a PFO are slightly more likely to have a stroke than people who do not. A PFO is more likely to be the cause of stroke in a younger adult because younger people don't have as many risk factors for stroke from other causes. Stroke can cause the following symptoms:
Most strokes do not result from a PFO. Even people who have a PFO often have strokes for other reasons.
A PFO can cause other complications as well. These include:
In many cases, your healthcare provider may choose not to treat your PFO directly. He or she may make suggestions about how to lower your overall risk for stroke. These might include:
Your healthcare provider might also give you tips to prevent getting blood clots in your legs. For instance, avoid sitting or standing in the same position for a long time. Make sure all your healthcare providers know about your PFO. Be sure to follow your healthcare provider’s instructions about medicine and lifestyle.
See a healthcare provider right away if you are having any symptoms of stroke. These include sudden weakness or numbness, confusion, difficulty seeing out of an eye, or loss of coordination.
Tips to help you get the most from a visit to your healthcare provider:
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