How is patent foramen ovale (PFO) treated?

Dr. Kent G. Meredith, MD
Cardiologist (Heart Specialist)

Patent foramen ovale (PFO) is a communication or small opening between the right (low oxygen) and left (high oxygen) sides of the heart. The PFO is a remnant of normal development of the heart, and is essential for survival of the fetus while in the womb. In most individuals, the PFO closes in early childhood. However, it may remain open in a large percentage of healthy adults. PFO is sometimes (mistakenly) confused with atrial septal defect (ASD), a birth defect caused by an incompletely-formed wall between the atrial chambers of the heart.

Whether and when a PFO should be closed is the subject of intense debate, and more clinical studies are needed before closure can be routinely recommended. A number of medical conditions have been suggested as having a possible association with PFO, including strokes and migraine headaches, but definitive proof showing a clear benefit to PFO closure is not yet available. Patients who have a PFO may wish to discuss their individual case with a physician who has specific knowledge in this area, and carefully consider both sides of the debate before making a decision.

If PFO closure is appropriate, the procedure can usually be done with a relatively simple catheter-based procedure. A catheter is placed in the leg vein, through which a small device can be delivered and implanted in the heart within the PFO. Over several months, scar tissue grows over the device, permanently sealing off the PFO.

Dr. Daniel P. O'Hair, MD
Cardiothoracic Surgeon

Atrial septal defect (ASD) is a hole in the atrium of the heart, and patent foramen ovale (PFO) is a hole between the two atria. These defects are common structural heart disease conditions.

Not all holes need to be repaired. A clear indication is when a person with a hole in the heart has had a stroke. That means, possibly, that a clot in a vein may have broken off and traveled to the heart and lungs, causing the stroke. A person with a hole in the heart is at great risk for having another stroke. When a person has a whole in the heart, a clot can pass through to the other side of the heart that pumps blood to the brain, which could lead to another stroke or death.

There are different treatment options:

  1. Surgery: There are two surgical options for ASD and PFO: traditional open chest surgery through the sternum or robotic surgery, which is performed through a small incision on the right side of the body.
  2. Patch: A patch is a catheter-based approach (in which a tube is placed in a vessel and a wire is guided to the problem area) to implant a patch over the hole. The patch covers the hole and prevents blood or clots from passing through.

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