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A foramen ovale is a hole in the heart. The small hole naturally exists in babies who are still in the womb for fetal circulation. It should close soon after birth. If it doesn’t close, the condition is called patent foramen ovale (PFO).
PFOs are common. They occur in roughly one out of every four people. If you have no other heart conditions or complications, treatment for PFO is unnecessary.
While a fetus develops in the womb, a small opening exists between the two upper chambers of the heart called the atria. This opening is called the foramen ovale. The purpose of the foramen ovale is to help circulate blood through the heart. A fetus doesn’t use their own lungs to oxygenate their blood. They rely on their mother’s circulation to provide oxygen to their blood from the placenta. The foramen ovale helps blood circulate more quickly in the absence of lung function.
When your baby is born and their lungs begin to work, the pressure inside their heart usually causes the foramen ovale to close. Sometimes it may not happen for a year or two. In some people, the closure may never happen at all, resulting in PFO.
In the majority of cases, PFO causes no symptoms.
In very rare cases, an infant with PFO could have a blue tint to their skin when crying or passing stool. This is called cyanosis. It usually only occurs if the baby has both PFO and another heart condition.
Most of the time, there’s no need to pursue the diagnosis of a PFO. However, if your doctor feels a diagnosis is necessary, they may recommend an echocardiogram. This technique uses sound waves to get an image of your heart.
If your doctor can’t see the hole on a standard echocardiogram, they may perform a bubble test. In this test, they inject a saltwater solution during the echocardiogram. Your doctor then watches to see if bubbles pass between the two chambers of your heart.
In most cases, people with PFO have no symptoms or complications. PFO is usually not a concern unless you have other heart conditions.
There is some evidence that adults with PFO may have a higher risk of stroke. But this is still controversial, and research is ongoing.
An ischemic stroke occurs when part of the brain is denied blood. This may happen if a clot becomes trapped in one of the arteries of your brain. Strokes can be minor or very serious.
Small blood clots may pass through the PFO and get stuck in the arteries of the brain in some people. However, most people with PFO won’t have a stroke.
There may be a connection between PFO and migraines. Migraines are very severe headaches that can be accompanied by blurred vision, shimmering lights, and blind spots. Some people who have had a PFO surgically corrected report a reduction in migraines.
In most cases of PFO, no treatment is necessary.
A PFO can be closed by a catheterization procedure. In this procedure, your surgeon inserts a plug into the hole using a long tube called a catheter that is usually inserted at your groin.
A PFO can be closed surgically by making a small incision, and then stitching the hole closed. Sometimes a doctor can repair the PFO surgically if another heart procedure is being done.
Adults with PFO who’ve had blood clots or strokes may need surgery to close the hole. Medication to thin blood and prevent clots from forming may also be prescribed instead of surgery.
The outlook for people with PFO is excellent. Most people will never even realize they have a PFO. Although stroke and migraines are possible complications of PFO, they aren’t common.
If you need surgery for a PFO, you should expect to recover fully and live a normal and healthy life.
Written by: Mary Ellen Ellis
Medically reviewed on: May 17, 2017: Debra Sullivan, PhD, MSN, RN, CNE, COI
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