The septum is the muscular wall separating the heart into the left and right sides. The atrial septum is the wall separating the atria (the two upper chambers). The ventricular septum is the wall separating the ventricles (the two lower chambers).
What is Foramen Ovale?
The foramen ovale is a small hole located in the septum (wall) between the two upper (atrial) chambers of the heart.
The foramen ovale is used during fetal circulation to speed up the travel of blood through the heart. When in the womb, a baby does not use its own lungs for oxygen-rich blood; it relies on the mother to provide oxygen rich blood from the placenta through the umbilical cord to the fetus. Therefore, blood can travel from the veins to the right side of the baby's heart and cross to the left side of the heart through the foramen ovale and skip the trip to the baby's lungs.
What is a Patent Foramen Ovale (PFO)?
Normally the foramen ovale closes at birth when increased blood pressure on the left side of the heart forces the opening to close.
If the atrial septum does not close properly, it is called a patent foramen ovale. This type of defect generally works like a flap valve, only opening during certain conditions when there is more pressure inside the chest. This increased pressure occurs when people strain while having a bowel movement, cough, or sneeze.
If the pressure is great enough, blood may travel from the right atrium to the left atrium. If there is a clot or particles in the blood traveling in the right side of the heart, it can cross the PFO, enter the left atrium, and travel out of the heart and to the brain (causing a stroke) or into a coronary artery (causing a heart attack).
Patent Foramen Ovale (PFO)
How Common is Patent Foramen Ovale?
PFO is present is up to 25 percent in the general population. Young adults (less than age 55) who have stroke of unknown cause (cryptogenic stroke), are more likely to have a PFO. In fact young adults who have had a cryptogenic stroke are more likely to have both a PFO and a deep vein thrombosis (DVT).
A PFO can be associated with atrial septal aneurysm, which is characterized by excessive mobility of the atrial septum.
Symptoms of PFO
Most patients do not have any symptoms with PFO.
Stroke and PFO:
A PFO is often not diagnosed until an adult has a transient ischemic attack (TIA) – symptoms of a stroke that last for less than 24 hours - or stroke. Symptoms of TIA or stroke include any of the following:
- Sudden weakness or numbness of the face, arm or leg on one side of the body
- Sudden blurred vision or decreased vision in one or both eyes
- Loss of speech, difficulty talking or understanding what others are saying
- Dizziness, loss of balance, unstable walking
- Sudden inability to move part of the body (paralysis)
Migraine headache and PFO:
Migraine headaches with aura are more common in patients with PFO. While it seems as though some patients have reported relief of headaches after closure of PFO, results of one randomized trial did not show improvement of migraine symptoms after closure. More studies need to be done.
Diagnosis of PFO
Patent Foramen Ovale can only be detected by specialized testing. If suspected, your doctor may order:
- Echocardiogram – a test that uses sound waves to create a moving picture of the heart’s internal structures and blood flow across the heart’s valves.
- Transesophageal echo (TEE) – an ultrasound test used to visualize the heart and defect, where an imaging probe with a camera is placed into the esophagus
- Bubble study – In some cases during an echo or TEE, the doctor may inject agitated saline through an IV in your arm with bubbles. During the test, the doctor can watch the echo to see if bubbles pass from the right to the left side of the heart to reveal the PFO.
Additional testing may be ordered as needed such as rhythm monitoring, blood testing for a hypercoagulable state (i.e. conditions that increase the risk of forming blood clots), and neurologic evaluation.
Treatment for Patent Foramen Ovale (PFO)
If you have a PFO but do not have symptoms or any associated problems, you do not need to be treated.
If you have a PFO and have had a stroke or TIA, your doctor may place you on some type of blood thinner or anti-platelet medication such as aspirin, plavix (clopidogrel), or coumadin (warfarin) to prevent recurrent stroke.
Closure of PFO
The best evidence has not shown that closure of a PFO surgically or with a device after a first idiopathic (no known cause) TIA or stroke is superior to medical therapy.
Therefore, closure of PFO is individualized and would be considered particularly for patients with recurrent idiopathic stroke or TIA while on blood thinning medications.
Living with PFO
Your doctor will tell you how often to make appointments for follow-up.
How to find a doctor if you have adult congenital heart disease
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, read more about our Sydell and Arnold Miller Family Heart & Vascular Institute outcomes.
The Center for Adult Congenital Heart Disease in the Sydell and Arnold Miller Family Heart & Vascular Institute is a specialized center involving a multi-disciplinary group of specialists, including cardiologists, cardiac surgeons and nurses from Cardiovascular Medicine, Pediatric Cardiology, Pediatric and Congenital Heart Surgery, Cardiothoracic Surgery, Diagnostic Radiology, Pulmonary, Allergy and Critical Care Medicine, and Transplantation Center, who provide a comprehensive approach to diagnosing and treating adult congenital heart disease.
Learn more about specialized teams of doctors who treat congenital heart disease.
You may also use our MyConsult second opinion consultation using the Internet.
For younger patients with congenital heart disease:
See: About Us to learn more about the Sydell and Arnold Miller Family Heart & Vascular Institute.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Becoming a Patient
Congenital heart disease is diagnosed by a murmur on a physical exam and several diagnostic tests:
Our webchats and video chats give patients and visitors another opportunity to ask questions and interact with our physicians.
View a calendar of events and register for future chats. Check the calendar for topics that interest you!
Why choose Cleveland Clinic for your care?
Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.
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