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Heart

Patent foramen ovale

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Definition

Patent foramen ovale (PFO) is a hole between the left and right atria (upper chambers) of the heart that fails to close naturally soon after a baby is born.

Alternative Names

PFO

Causes, incidence, and risk factors

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.

Signs 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.

Expectations (prognosis)

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

Complications

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

Older people with PFOs may have a higher rate of a certain type of stroke (called paradoxical thromboembolic stroke), because they often develop blood clots in their leg veins. These clots can sometimes travel to the right side of the heart. The clot can pass from the right side to the left side of the heart. It may 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.

Calling your health care provider

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: Saunders Elsevier; 2011:chap 65.

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