Understanding Patent Foramen Ovale (PFO)

Patent Foramen Ovale (PFO) is a heart condition that occurs when there are holes in the wall of tissue between the left and right upper chambers of the heart.

According to the American Heart Association (AHA), more than a quarter of the population has a hole in their heart, but in most cases this condition does not cause major health problems.

PFO is one type of hole in the heart, the other is called atrial septal defect (ASD).

Symptoms of PFO (Hole in the heart)

Most people with PFO do not have any symptoms. However, the condition could be tied to migraine headaches, shortness of breath and increases the risk of stroke, transient ischemic attack (TIA, often called a ministroke) and heart attack. According to the AHA, while 25% of the general population has PFO, this increases to about 40 to 50 percent in patients who have a stroke of an unknown cause (which is called a cryptogenic stroke). This is also true in patients who have had a stroke before age 55.

There are many causes of having a stroke. Having a PFO does not account for a large number of these unknown stroke causes. Having a hole in the heart does not cause a stroke. Rather, the hole provides an opening for a tiny blood clot to pass from the right to the left side of the heart, which can travel to the brain and cause a stroke.

PFO Treatment Options

A PFO is diagnosed using an echocardiogram. For patients with PFO, it is not usually necessary to have surgery to close the hole in the heart. Patients with PFO who have had a stroke or TIA may need to take a blood-thinning medication (like aspirin) to prevent blood clots and stroke.

In most cases, PFO closure is considered if a patient has had more than one cryptogenic stroke or TIA and after they start taking blood-thinning medication. A heart doctor will determine if a PFO closure is the best treatment option for the patient.

PFO Closure Procedure

A cardiac catheterization is a procedure in which a catheter, through a small incision, is inserted into a large vein (usually in the groin area) and then advanced to the heart. An ultrasound imaging device (used to get a better view of the heart) is also advanced up to the heart through the vein. The ultrasound imaging device also helps the cardiologist determine the size of the PFO closure device that is needed.

During the procedure, a PFO closure device is advanced through the vein to the heart to the exact location of the heart wall defect. The PFO closure device “straddles” each side of the hole and remains permanently in the heart. This stops the abnormal blood flow between the two atrial chambers of the heart. Once the catheter is removed, the procedure is complete. A PFO closure procedure typically takes one to two hours.

Are there any risks associated with a PFO closure procedure?

A PFO closure is a minimally-invasive procedure that does not require extensive cardiac rehabilitation — which, for example, might be necessary for someone who has undergone open heart surgery. The materials used for the PFO closure device have been proven safe and are widely used in heart surgery procedures. While very uncommon, complications from a PFO closure might include atrial fibrillation (AFib), bleeding, or blood clots in the leg or the lung.

Does a PFO closure reduce the risk of having another stroke?

There is a lot of new research that looks at whether or not a catheter-based PFO closure procedure reduces the risk of stroke. One recent clinical trial suggests that patients who underwent a PFO closure and were treated with blood-thinning drugs had a lower rate of stroke than patients who were treated with blood-thinning drugs alone.

Some studies suggest that a PFO closure decreased the rate of recurrent or repeated stroke, in comparison to medical therapy. More medical studies are underway to evaluate this data. Talk to your heart doctor about the latest research involved in this procedure for more details.

Innovative and Advanced Treatment Options in Denver

At Denver Heart, our highly-qualified, expert surgeons are on the front lines of offering innovative and technology-advanced treatment options for patients with heart disease. We specialize in routine and complex procedures for a large number of heart-related conditions. Denver Heart provides personalized care and individual treatment options for each patient.