Patent foramen ovale (PFO)

What is a PFO?

A patent foramen ovale (PFO) refers to a persistent opening between the upper two chambers of the heart, known as the atria. During fetal development, this opening allows blood to bypass the immature fetal lung. Post-birth, as the lung matures, this passage typically closes.

What is the significance of a PFO?

  • Roughly 20-25% of the population has a PFO.
  • For most individuals, this opening doesn’t cause any adverse effects.
  • However, a subgroup might experience symptoms or complications associated with a PFO, such as stroke, transient ischemic attack (TIA or mini-stroke), migraine with aura, decompression sickness, or shortness of breath (platypnea‐orthodeoxia syndrome).

Who should consider treatment for PFO?

  • Individuals experiencing symptoms potentially linked to a PFO may contemplate closure.
  • The most compelling reason for closure is a history of stroke or mini-stroke.
  • Further tests are conducted to rule out symptoms originating from another cause.

What are the treatment options for a PFO?

  • Treatment involves medications or closure of the PFO; additional assessments may be needed to determine the most suitable option.
  • PFO closure methods include open heart surgery or a minimally invasive transcatheter procedure. Transcatheter closure is less invasive and boasts a quicker recovery compared to open heart surgery.

What risks are associated with transcatheter closure of PFO?

  • Bleeding
  • Infection
  • Abnormal heart rhythm (e.g., atrial fibrillation, sudden cardiac death)
  • Cardiac perforation
  • Aortic injury
  • Device dislodgement
  • Stroke

What can be expected during and after the procedure?

  • The PFO closure is typically an outpatient procedure lasting approximately 2-3 hours, including pre- and post-operative monitoring and setup.
  • Most individuals are discharged on the same day.
  • Following the procedure, you might be prescribed blood thinners like aspirin and clopidogrel for several months.