Patent Foramen Ovale (PFO)
Overview
What is a patent foramen ovale (PFO)?
A patent foramen ovale (PFO) is a hole in the wall between the heart's two upper chambers (atria). Before birth, all babies have this opening. It allows oxygen-rich blood from the umbilical cord to flow through the fetal heart and to the rest of the fetus's body. The lungs take on this job after the baby is born and starts breathing. Normally, the opening closes during infancy. In some people, however, it doesn't close. The resulting hole is called a patent foramen ovale.
PFO is common – about one in four adults have it. Because the condition usually doesn't cause symptoms, most people with a PFO never know they have it. A PFO is only a concern if there are complications, such as a stroke.
Our approach to PFOs
The UCSF Adult Congenital Heart Disease Clinic provides comprehensive, highly specialized care for people living with heart defects like PFOs. Because PFOs are often discovered after someone has a stroke, our neurologists and heart care specialists work together to provide evaluations, advanced treatments and long-term monitoring for patients with PFOs. If PFO closure is needed, our interventional cardiologists are experts in performing a minimally invasive repair procedure, which has the benefits of less post-op pain, faster recovery and less scarring than open-heart surgery.
Awards & recognition
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Among the top hospitals in the nation
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One of the nation's best for heart & vascular surgery
Symptoms of PFO
Most people with a patent foramen ovale don't have symptoms. Some discover they have a PFO after having a heart imaging test for other reasons.
Signs that you may have a PFO include:
- A stroke or "ministroke" with no apparent cause. If a blood clot goes through the PFO and blocks a blood vessel leading to the brain, this can cause a stroke or a milder "ministroke" known as a transient ischemic attack (TIA). Having a stroke or TIA of unknown cause – especially before the age of 55 – is the most common way people learn they have a PFO.
- Hypoxemia, or low oxygen levels in the bloodstream. This can happen when too much blood flows through the PFO and is pumped out to the body, instead of circulating through the lungs (where it would receive oxygen). Hypoxemia can make you feel dizzy or short of breath.
Diagnosis of PFO
If you have a stroke or TIA with no clear cause, your neurologist or cardiologist may refer you for an echocardiogram to check for a patent foramen ovale (PFO). This test uses sound waves to create detailed images of the inside of your heart.
Often, the echocardiogram is combined with a bubble study. A bubble study is a safe and painless test in which a sterile saltwater solution, shaken to form tiny bubbles, is injected into a vein. The tiny bubbles travel to the heart, where their movement is tracked by the echocardiogram. If the bubbles move from the right side of the heart to the left, this indicates an opening, or PFO, between the two chambers.
Treatment of PFO
A patent foramen ovale doesn't need treatment unless it has caused a problem like a stroke or a TIA. In these cases, your doctor will recommend closing your PFO to reduce the risk of subsequent events.
PFO closure
Minimally invasive PFO closures are performed by interventional cardiologists (cardiologists who specialize in catheter-based diagnoses and treatments) in our cardiac catheterization lab. You are sedated but not completely asleep during the procedure, which takes about an hour.
The doctor makes a small incision in a large vein in your groin and then inserts a catheter (a long, thin, flexible tube) with a closure device on the tip. Guided by X-ray and ultrasound imaging, the doctor threads the catheter through blood vessels to reach the PFO. They then place the closure device over the PFO to permanently seal the opening between the two chambers. Once this repair is complete, the doctor removes the catheter.
Following the procedure, your care team will monitor you in the recovery area for approximately four to six hours. Most people go home the same day. Before discharge, you'll have another echocardiogram to check that the closure device is in the right place.
Follow-up care after PFO closure
You'll have a follow-up visit with the interventional cardiologist about one month after your procedure. You'll also have regular checkups with your primary care provider and local cardiologist.
To help prevent blood clots and reduce your stroke risk, you'll need to take a daily aspirin for six months to a year and another blood-thinning medication for at least six months. For six months after the procedure, you'll also need to take antibiotics anytime you have dental work or if you have surgery involving your bladder, stomach or lungs.
During your clinic visit before the procedure, your doctor will provide you with more detailed follow-up information.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
