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Diagnosis & Treatment

Patent Foramen Ovale (PFO)

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How is Patent Foramen Ovale (PFO) Diagnosed?

Diagnosis

A PFO is usually discovered while testing for another health issue. Your doctor may order one of the following specialized tests to diagnose PFO:

  • Echocardiogram (transthoracic echocardiogram) - An echocardiogram is an ultrasound test that uses sound waves to look at the structures and function of the heart. The images are obtained from the chest wall. This a common test used to determine a PFO diagnosis in children and adults.
  • Bubble study/test - During an echocardiogram, you will receive a saline solution (salt and water) injection. The solution will show up as bubbles that can be tracked as flowing from the right atrium to the left.
  • Transesophageal echocardiogram - Similar to a traditional echocardiogram, this test is done using a long probe with a small transducer (microphone-like device) attached to the end. The probe is placed into the mouth and guided down the esophagus, which sits directly behind the heart. Currently, this is the most accurate way to diagnose PFO.
  • Transcranial Doppler examination - This is another ultrasound test in which the blood flow in the artery under the temple is evaluated. When salt water is injected into the patient's IV (bubble test), if no bubbles cross the heart wall, the sound of the ultrasound signal does not change. If there is a PFO and salt water crosses to the left side of the heart, it is then pumped to the body, including the head, and can be detected by the ultrasound signal. This is the most sensitive test for finding the right-to-left flow associated with PFO.

How is Patent Foramen Ovale Treated?

Treatment

People who don’t experience symptoms from patent foramen ovale usually don’t require treatment. However, for patients with PFO who have had blood clots, strokes, or other serious complications, certain medicines and surgical procedures may be recommended.

The most common treatments for patent foramen ovale are:

  • Medications - Antiplatelets and anticoagulants (blood thinners) can be prescribed to help prevent blood clots
  • Surgical closure with cardiac catheterization - The PFO hole can be closed by inserting a thin, flexible tube (catheter) through a blood vessel in the groin and up to the heart. The catheter has a small device on its tip used to plug up the hole. Surgical repair of the PFO is not often required, unless the surgery is done to repair another issue at the same time.
  • Surgical closure during heart surgery - A cardiac surgeon can stitch shut the PFO hole. This surgical heart procedure can be accomplished with a tiny incision and robotic techniques.

FAQs

FAQs

Generally speaking, a PFO doesn't change as patients age. But other changes in the heart and the circulation may change the pressures in the heart on each side of the flap, leading to more frequent opening of the flap and wider opening of the flap. This may increase the likelihood of additional symptoms.

Unless a patient has symptoms, there is no reason to look for a PFO. The majority of people with a PFO never have medical issues related to their condition.

A PFO closure is a surgical procedure to close the hole that should have sealed on its own after birth. It can be accomplished by a cardiac catheterization or stitched closed during open-heart surgery.

There can be minor pain and some bruising at the catheter insertion site in the leg, similar to when you get blood drawn from your arm in the doctor's office. Some patients may experience some intermittent heart flutters or skipped beats for a few weeks after the procedure. Some patients, particularly those with a history of migraines, may also have headaches in the first week.

After 10 - 14 days, the patient can return to full activity levels, including strenuous exercise. In some cases, an echocardiogram, electrocardiogram, and chest X-ray may be performed after the procedure. Blood-thinning medication will be given for the first few months to prevent blood clots from forming on the umbrella, and follow-up exams will be scheduled over the next year to monitor the device.

The families of patients with stroke and other clot-related issues have no more risk of a PFO than the general population—around 25%. In general, family members without symptoms are not tested. However, in patients with PFO-related migraines, family members with migraine are likely to have PFO and should be tested.
 

This content has been reviewed by the following medical editors.

Robert J. Sommer, MD

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Trust NewYork-Presbyterian for Patent Foramen Ovale Treatment

NewYork-Presbyterian is one of the nation’s leading centers for treating congenital heart issues, including patent foramen ovale. Our world-renowned cardiologists are leading ongoing research in the relationship between stroke and PFO, and much of the foundational research linking migraine to PFO has been done by our faculty.

We are experts in identifying the symptoms and causes of patent foramen ovale, and can perform any of the required diagnostic and catheter-based procedures to help lower your risk of heart complications.

 If you’ve been diagnosed with patent foramen ovale and are experiencing symptoms or complications, contact NewYork-Presbyterian for an appointment with our cardiac team.