Patent Foramen Ovale – Diagnosis and Treatment
Patent foramen ovale, often called PFO, is a small opening between the upper chambers of the heart. This opening normally closes shortly after birth, but in some people, it remains open.
PFO is a type of heart defect present at birth and relates to congenital heart defects like atrial septal defect (ASD), though it is usually smaller and less serious.
Many individuals with a PFO have no symptoms and may not even know they have it. However, in some cases, it can increase the risk of certain problems, such as stroke.
Diagnosis
Heart Imaging and Related Tests
Doctors often discover a patent foramen ovale (PFO) by using special imaging exams. These tests focus on the heart’s shape, the movement of blood, and the thin wall between the upper heart chambers (called the atrial septum).
The main tool is an echocardiogram, which uses sound waves to produce live pictures of the heart.
This test lets doctors see the heart chambers, valves, and blood flow patterns, helping them check for any right-to-left shunting—a sign that blood moves through an unexpected opening.
Doctors may also use other exams, such as a transcranial Doppler (which looks for abnormal blood flow in the brain) and sometimes a chest x-ray. However, the chest x-ray is less specific for detecting a PFO.
Standard Heart Ultrasound From the Chest
The basic way to check for a PFO is a transthoracic echocardiogram (TTE). Here’s a step-by-step look:
- The doctor places a small device (transducer) on the skin near the chest.
- This device sends out sound waves, which “bounce back” from the heart and create live images on a computer.
- TTE shows both the working heart and the direction of blood flow through it.
Often, doctors use two extra features during this test:
1. Color Doppler Imaging
This method shows the speed and direction of blood flow with color highlights. It helps reveal if blood crosses from one upper heart chamber to the other, which suggests a PFO.
2. Bubble Study (Saline Contrast Test)
A saltwater mix with tiny air bubbles is injected into a vein. These bubbles head to the right chamber of the heart. If the atrial septum has a hole, some bubbles will move to the left chamber.
The movement can be tracked during the echocardiogram, helping doctors spot unusual pathways.
| TTE Methods | What It Shows |
|---|---|
| Regular TTE | Heart structure, basic blood flow |
| Color Doppler | Speeds/directions of blood, shunts |
| Bubble Study | Bubbles crossing atrial septum, PFO signs |
Internal Heart Ultrasound With a Probe
In some cases, a regular echocardiogram does not give clear enough images. For a better view, doctors use a transesophageal echocardiogram (TEE). During this exam:
- A thin, flexible tube with a special ultrasound tip is gently passed down the throat into the esophagus (the food pipe behind the heart).
- The probe gets much closer to the heart than a standard TTE.
- TEE produces highly detailed images of the heart, the atrial septum, and the flow of blood between the chambers.
Because TEE provides higher quality images, doctors consider it the best test for confirming a patent foramen ovale.
Additional Details
When reviewing all test results, doctors look for direct and indirect signs of blood moving between the heart’s upper chambers.
The choice of tests depends on the patient’s health, symptoms, and test results. If there is still doubt, heart or brain specialists may recommend specialized tests.
Treatment
Medicine Options
Some people with a patent foramen ovale (PFO) need medicine to help prevent health problems. Doctors sometimes use blood thinners, also called anticoagulants, to lower the chance of blood clots forming.
Blood clots can sometimes pass through the PFO and travel to the brain, which could lead to a stroke.
Other medications, like antiplatelet drugs, may also be recommended to reduce the risk of stroke, especially for people who have already had a cryptogenic stroke.
| Medication Type | Purpose |
|---|---|
| Antiplatelets | Prevent clots from sticking together. |
| Anticoagulants | Thin the blood to avoid clot formation. |
Doctors choose these drugs based on the patient’s health and history. Some people need medicine long-term, but not everyone with a PFO will need these treatments.
Procedures and Operations
If someone has a higher risk for stroke or low blood oxygen due to a PFO, a doctor might suggest closing the opening. There are two main ways to do this:
- Catheter-Based PFO Closure: In this non-surgical method, a thin tube (catheter) is guided through a blood vessel, usually from the groin, up to the heart. A small device at the tip of the catheter plugs the hole. Doctors often use this to help reduce the risk of paradoxical embolism or for people who have had strokes that cannot be explained. Complications are rare but can include heart or blood vessel injury, device movement, or irregular heartbeats.
- Surgical Repair: This is heart surgery where stitches close the PFO. Doctors typically do this only if another heart surgery is planned. In some cases, minimally invasive or robotic techniques may be used to reduce recovery time and scarring.
Taking Care of Yourself
People living with a patent foramen ovale (PFO) who do not have symptoms can usually follow their usual routines without special limits. Maintaining heart health through regular exercise is helpful for overall wellness.
When traveling far, especially on flights or long car rides, they should:
- Take breaks to stand and walk.
- Drink enough water.
- Stretch their legs often.
These steps can help lower the risk of blood clots and support heart health.
Getting Ready for Your Visit
Being prepared for a visit with a cardiologist or healthcare provider helps you get the most out of the appointment. Write down any symptoms you’ve noticed, even if they don’t seem related to your heart.
Bring a list of medicines, including vitamins or supplements, and any questions you want answered. Be open about all your medical history and other health problems.
If you have questions about how a patent foramen ovale (PFO) might affect other conditions, let your provider know. They can work with you to make a plan that fits your needs.
Questions to Consider Asking:
- What could have caused my PFO?
- Is this condition dangerous for me?
- What treatment options do I have and which is best?
- Are there risks to closing the PFO?
- Should I limit certain activities?
- Is there a chance my child could have this?
Consider bringing a family member or friend to the appointment. They can help you remember answers and offer support, especially if you get nervous.
If your cardiologist recommends tests, like an echocardiogram, ask what will happen during and after the test so you know what to expect.
Below is a simple table for organizing your preparation:
| Task | Why It Matters |
|---|---|
| List your symptoms | Better diagnosis |
| Bring medication list | Avoids drug interactions |
| Write down questions | Helps you get needed answers |
| Share your medical history | Ensures safe, effective care |
| Bring a friend or family member | Extra support and note-taking |
Having details ready can help your healthcare provider make the best choices for your health.
If you have more than one health issue, let them know so both can be managed safely. Make sure to get clear guidance on activity limits or treatments.
Ask for resources to read if you’re interested in learning more at home. Bringing your own notes about symptoms and concerns helps keep the discussion focused on what matters most to you.
Additional Details
A patent foramen ovale (PFO) is an opening in the heart that is present in many newborns but usually closes as they grow. If the PFO does not close, it can stay into adulthood.
Most people with a PFO do not have symptoms, but the condition can sometimes lead to health concerns.
Some possible issues include decompression sickness for divers and a higher risk of stroke. A PFO has also been linked to some cases of migraine headaches.
In some cases, an atrial septal aneurysm (ASA) may occur along with a PFO, which can affect the heart’s rhythm or cause other complications.
Doctors may use tests like an electrocardiogram (ECG) to check heart rhythm. Other tests look for signs of pulmonary hypertension or heart failure, but these problems are rare in people with only a PFO.
Treatment is usually only needed if the PFO causes health issues, such as migraines that do not improve or unexplained strokes.
Common Concerns Linked to PFO:
| Concern | Possible Connection with PFO |
|---|---|
| Decompression sickness | Increased risk in divers. |
| Migraine headaches | Can be more common in people with PFO. |
| Heart rhythm | May be affected if ASA is present. |
| Heart failure | Rare, unless other heart problems exist. |
| Pulmonary hypertension | Uncommon without other conditions. |
Some people with a PFO never experience problems. If symptoms occur, health professionals offer guidance and specialized care to help manage the condition.
