Patent Foramen Ovale

Signs and Symptoms

Most infants with a patent foramen ovale (PFO) won't experience symptoms. In some cases, though, a baby with a PFO and other heart or lung problems may turn blue, a condition known as cyanosis, when coughing, crying or having a bowel movement.

Adults with a PFO also rarely experience symptoms. Occasionally, patients may experience episodes of shortness of breath and cyanosis. In most cases, a PFO is diagnosed during the evaluation of possible causes of a stroke.<.p>

Diagnosis

To diagnose a patent foramen ovale (PFO), your doctor will ask about your medical history and conduct a thorough medical exam. You also will have a test called an echocardiogram to make a definite diagnosis. This is a non-invasive test that uses sound waves to create detailed moving images of your heart.

Treatment

Treatment of a patent foramen ovale (PFO) is necessary only if the condition causes problems. In the past, open-heart surgery with a long recovery period was required. Heart specialists now close PFOs with a non-surgical procedure that involves cardiac catheterization and a special device that patches the hole between the right and left atrium.

The PFO closure is conducted in our Pediatric Cardiac Catheterization Laboratory and takes about two and a half hours. Patients are allowed to return home the same day as the procedure or the following morning.

First, patients undergo cardiac catheterization. This procedure involves a catheter, a long, flexible narrow tube, which is inserted into a vein in the leg or neck and threaded through the vein to the heart. The size of the PFO is then measured and a repair device is selected for closure. If the PFO is unusually large, catheter closure may not be possible.

A PFO closure device consists of two small metal umbrellas or disc-like frames that fold against each other. These frames or discs are connected at their centers and covered with synthetic fabric. The device is folded into a special catheter positioned in the left atrium. One side of the patch is opened and positioned against the atrial wall covering the hole on the left side. As the remaining umbrella opens in the right atrium, it folds against the atrial wall holding the device in place and closing the PFO. Over time, heart tissue grows over the implant and becomes part of the heart.

Complications

Complications during PFO closure are rare and almost all can be treated immediately. There is a small risk of blockage of the groin vessels used for catheterization, although these usually can be treated with medication. Serious complications such as stroke are extremely rare, occurring in less than one in over 400 patients. Complications occurring days after the procedure, such as breakage, movement or infection of the device, also are extremely rare, occurring in less than 1 percent of patients.