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Patent foramen ovale

Patent foramen ovale (PFO) is a hole between the left and right atria (upper chambers) of the heart. This hole exists in everyone before birth, but usually closes shortly after being born. PFO is what the hole is called when it fails to close naturally after a baby is born.

Alternative Names

PFO

Causes

A foramen ovale allows blood to go around the lungs. A baby's lungs are not used when it grows in the womb, so the hole does not cause problems in an unborn infant.

The opening is supposed to close soon after birth, but sometimes it does not. In about 1 out of 4 people, the opening never closes. If it does not close, it is called a patent foramen ovale (PFO).

The cause of a PFO is unknown. There are no known risk factors.

Symptoms

Infants with a patent foramen ovale and no other heart defects do not have symptoms.

Exams and Tests

An echocardiogram can be done to diagnose a PFO. If the PFO is not easily seen, a cardiologist can perform a "bubble test." Saline solution (salt water) is injected into the body as the cardiologist watches the heart on an ultrasound (echocardiogram) monitor. If a PFO exists, tiny air bubbles will be seen moving from the right to left side of the heart.

Treatment

This condition is not treated unless there are other heart problems, or the person had a stroke caused by a blood clot to the brain.

Treatment usually requires a procedure called cardiac cathertization, which is performed by a trained cardiologist to permanently seal the PFO.

Outlook (Prognosis)

An infant who has no other heart defects will have normal health.

Possible Complications

Unless there are other defects, there are usually no complications from a PFO.

Very rarely, people with PFOs may have a higher rate of a certain type of stroke (called paradoxical thromboembolic stroke). In a paradoxical stroke, a blood clot that develops in a vein (often leg veins) breaks free and travels to the right side of the heart. Normally, this clot would then continue to the lungs, but in someone with a PFO, the clot could pass through the hole to the left side of the heart. It may then be pumped out to the body, travel to the brain and become stuck there, preventing blood flow to that part of the brain (stroke).

Some patients may take medication to prevent blood clots.

When to Contact a Medical Professional

Call your health care provider if your baby turns blue when crying or having a bowel movement. Usually, this disorder is only discovered when a cardiologist performs an echocardiogram (ultrasound of the heart) for an unrelated heart murmur.

References

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 65.

Updated: 11/5/2013

Kurt R. Schumacher, MD, Pediatric Cardiology, University of Michigan Congenital Heart Center, Ann Arbor, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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