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Patent Foramen Ovale Diagnosis

The foramen ovale (fo-RA-mun o-valley) is associated with the heart. Occurring as a normal part of our anatomy, it goes to work long before birth to keep blood circulating appropriately. Its job, however, is temporary. If the foramen ovale does not cease its function after birth, it becomes a patent (open) foramen ovale or "hole in the heart."

  1. Heart Function

    • The heart has four chambers, two upper (atria) and two lower (ventricles). A septum (muscular wall) divides the heart into right and left sides. The atrial septum separates the upper chambers. The ventricular septum separates the two lower chambers. Oxygen-poor blood from the body enters the right atrium, which pumps it to the right ventricle. The right ventricle sends blood to the lungs where it picks up oxygen and returns it to the left atrium, which pumps it to the left ventricle. The left ventricle then pumps oxygenated blood back out to the body.

    Prenatal Heart Function

    • Since we do not breathe before birth, the umbilical cord sends oxygen-rich blood to the right atrium. The prenatal heart has a small flap-like opening in the wall between the right and left atrium---the foramen ovale. Blood travels directly from the right to the left atrium, skipping the lungs, and then into the left ventricle, which sends it out to the body. Once lung function begins, the pressure in the left atrium forces the foramen ovale closed. If it does not close, it becomes a patent foramen ovale (PFO).

    Symptoms

    • According to MayoClinic.org, one in four people have PFO. Many will never realize it since there are usually no associated signs or symptoms. A newborn with PFO might have cyanosis (bluish skin) when crying or straining. MayoClinic.com reports, however, that an infant with cyanosis and patent foramen ovale typically has other heart defects. In these cases, the PFO may actually be necessary since it allows an imperfect but alternate route for blood to circulate.

    Complications

    • PFO does not typically create complications but may be a risk factor for stroke. Doctors theorize that tiny clots of blood, which typically lodge in the lungs and dissolve, may travel through the PFO and then out of the heart to the brain. MayoClinic.com reports, however, that evidence for this is inconclusive. PFO might be a link to migraines with aura. Cleveland Clinic, noting migraine sufferers sometimes improve with PFO closure, recommends further research regarding this.

    Diagnosis and Treatment

    • PFO is typically an incidental finding on echocardiogram, a procedure doctors use to evaluate heart function. Treatment with aspirin or Coumadin thins the blood and may reduce risk of stroke. Doctors may decide to close the PFO in patients with history of unexplained stroke or debilitating migraines. Surgical repair by opening the heart and suturing the PFO shut is an option. Doctors also use heart catheterization to place a device that seals the hole. In this procedure, the physician threads a long thin tube carrying the closure device through the veins from the groin to the heart.

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