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Patent Foramen Ovale

What is a patent foramen ovale?

The foramen ovale is a small opening between the 2 upper chambers of the heart (the atria). It is normally present before birth and closes in most people after birth. If the foramen ovale does not close all the way, it is called a patent foramen ovale (PFO).

How does it occur?

The foramen ovale lets blood skip the trip to the lungs. Before birth a baby’s blood does not need to go through the lungs to pick up oxygen because the baby gets oxygen-rich blood from the mother. After birth, increased blood pressure on the left side of the heart normally forces the flap over the hole to close the hole, so all of the blood then travels from the right side of the heart to the lungs.

Sometimes the flap does not seal. When this happens, the foramen ovale may open at times, and less blood will get to the lungs to pick up oxygen.

It is not known why the flap seals after birth in most people but not everyone.

What are the symptoms?

A patent foramen ovale usually does not cause any symptoms. In rare cases a baby with PFO may turn blue when crying or straining to pass a bowel movement.

How is it diagnosed?

The best test for diagnosing a patent foramen ovale is a transesophageal echocardiogram. It uses sound waves and a computer to look at your heart. During the test a small amount of fluid is injected into your veins. The fluid contains tiny bubbles that are detected by the echocardiogram. This helps your healthcare provider see how blood is flowing in the heart.

How is it treated?

Most people with PFO do not need any treatment. If you are having surgery for other problems with the heart, the hole may be closed during the surgery. The hole may also be closed if your blood oxygen levels are too low. Sometimes healthcare providers recommend closing the hole to prevent recurring stroke or to treat migraine headaches, but there is disagreement about whether treatment of PFO is helpful in these cases. The hole may be closed with surgery or with heart catheterization to place a device to plug the hole.

Some healthcare providers may prescribe medicine such as warfarin or aspirin to try to reduce the chance of blood clots that might cause a stroke, but the benefits of this treatment are not clear.

What are possible complications?

PFO may increase the risk of stroke, but the evidence for this is not clear. It may also be linked to migraine headaches with aura, but this also has not been proven.

If you have pulmonary hypertension, PFO may make shortness of breath much worse.

Scuba divers with PFO may be more likely to have small strokes and damage to the brain when they dive. During decompression after diving, small nitrogen bubbles may form in the blood. These bubbles may act like blood clots and cause small strokes or brain damage. Talk with your healthcare provider if you are a diver.

How can I help take care of myself?

Keep all of your regular checkup appointments with your healthcare provider.

Call your healthcare provider if:

  • You suddenly have more trouble breathing.
  • You wake up at night short of breath.
  • Your heartbeat is irregular.

Written by Edward Havranek, MD, for RelayHealth.
Published by RelayHealth.
Last modified: 2011-02-04
Last reviewed: 2010-03-11

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a health care professional.

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