Foramen Ovale

A small opening in the heart, called a patent foramen ovale (PFO), happens when a tiny flap-like passageway between the heart's upper chambers (the atria) doesn't close properly after birth.

Before a baby is born, there's an opening called the foramen ovale that helps blood flow efficiently. Normally, this opening closes shortly after birth. If it doesn't close completely, it's called a patent foramen ovale.

In most cases, a PFO doesn't cause any problems and doesn't require any treatment.

A hole in the heart, called a patent foramen ovale (PFO), is quite common. About one out of every four people has one. Importantly, most people with a PFO don't experience any symptoms and don't even know they have it. Often, a PFO is only found when a person is getting checked for something else, like a different health issue.

Sometimes, a small opening in the heart called the foramen ovale doesn't close after birth, and it's not entirely understood why this happens. One possibility is that a person's genes might influence whether or not the opening closes. Scientists are still studying this.

A patent foramen ovale (PFO) is a small hole in the heart that's usually harmless. Most people with a PFO don't experience any problems. However, in some cases, a PFO can lead to complications.

Sometimes, a PFO can allow blood to bypass the lungs, reducing the amount of oxygen in the blood. This is called hypoxemia. It's a rare complication.

Another possible problem is a stroke. Small blood clots sometimes form in the veins. If a clot travels to the heart through the PFO and into the side of the heart that pumps blood to the body, it can then travel to the brain. If the clot blocks blood flow to the brain, it can cause an ischemic stroke.

Some research suggests that people who have unexplained strokes or migraines with a visual aura (like flashing lights or blind spots) might be more likely to have a PFO. But this isn't always the case. There are other possible causes for these conditions, and having a PFO might just be a coincidence. More studies are needed to understand the connection more clearly. In most cases, there are other reasons for these events, and the PFO is likely just a factor present in some people.

A patent foramen ovale (PFO) is often discovered during medical tests for other health issues. If a doctor suspects a PFO, they might order heart imaging tests.

If a PFO is found, and it's linked to a stroke, you might be referred to a neurologist, a doctor specializing in the brain and nervous system.

Doctors use an echocardiogram to diagnose a PFO. This test uses sound waves to create pictures of the heart's structure and how blood flows through it. It's like a moving movie of your heart.

A standard echocardiogram works by using a special ultrasound device (a transducer) placed on your chest. The device sends sound waves into your heart, and the echoes are used to create images on a computer screen.

There are different ways to perform an echocardiogram to look for a PFO:

• Color Doppler: This technique looks at the speed and direction of blood flow. As blood cells move through the heart, the sound waves bounce off them, changing slightly in pitch. These changes show up as different colors on the image. If you have a PFO, this test often shows blood flowing between the top chambers of your heart.

• Saline Contrast Study (Bubble Study): During a standard echocardiogram, a sterile salt solution with tiny bubbles is injected into your bloodstream. These bubbles travel through your heart. If there's no hole between the top heart chambers, the bubbles are filtered out in the lungs. If a PFO is present, some bubbles will show up on the left side of your heart, because they've passed through the hole. This test is helpful in confirming the presence of a PFO when a standard echocardiogram might not be clear.

• Transesophageal Echocardiogram (TEE): Sometimes, a standard echocardiogram isn't enough to clearly see a PFO. A TEE provides a more detailed view. In this procedure, a flexible tube with an ultrasound device at the end is passed down your throat into your esophagus (the tube connecting your mouth to your stomach). This allows for a closer look at the heart and is often considered the most accurate way to diagnose a PFO.

Many people with a patent foramen ovale (PFO) don't need any treatment. A PFO is a small hole in the heart. If a doctor finds a PFO during a routine heart ultrasound (echocardiogram) for other reasons, they usually won't recommend closing it.

However, some people do need treatment. In these cases, treatment options might include:

• Medications: Doctors might prescribe blood thinners to help prevent blood clots from forming. This is especially helpful for people who have had a stroke and who have a PFO. Blood thinners are intended to make the blood less likely to clot, which is important for preventing further strokes.

• Procedures to close the hole: This is necessary in specific situations. If you have a PFO and have had an unexplained stroke or have low blood oxygen levels, a procedure to close the hole might be recommended. Also, if a stroke recurs after a PFO is found, this may be an option. However, closing the hole to prevent migraines is generally not recommended as a first-line treatment. Closing the hole to prevent future strokes is reserved for cases where specialists in heart and brain conditions believe it will be beneficial.

There are two main ways to close a PFO:

1. Device Closure:

A thin, flexible tube (a catheter) is inserted into a blood vessel in the groin. The tip of the catheter has a small device designed to plug the hole in the heart. The doctor guides the catheter to the PFO and uses the device to close it. This procedure is generally safe, but rare complications can occur, including:

• Problems with the heart or blood vessels: A small tear in the heart or blood vessels is a possible, but uncommon, complication.
• Device movement: Sometimes, the device can move from its intended position.
• Irregular heartbeats: In some cases, the procedure might cause temporary changes in the heart's rhythm.

2. Surgical Closure:

A surgeon can close the PFO during a heart operation. This can be a minimally invasive procedure, using a small incision, or even robotic techniques. If a person needs heart surgery for another reason, the doctor may recommend closing the PFO at the same time.

In summary, treatment for a PFO depends on the individual's specific situation. If you have concerns about a PFO, it's crucial to discuss them with your doctor. They can determine if treatment is necessary and recommend the best course of action based on your particular circumstances.

If you have a patent foramen ovale (a small hole in your heart) and you aren't experiencing any symptoms, you likely don't need to change how you live your daily life.

However, if you plan to travel long distances, there are some important things to keep in mind to help prevent blood clots. For example, if you're driving, take breaks regularly and try to get out and walk around for a little while. This helps keep your blood flowing. On a plane, drinking plenty of water and moving around when possible is crucial for similar reasons. Staying hydrated and moving around can help prevent blood clots from forming, especially on long flights.