Patent Foramen Ovale
A patent foramen ovale (PFO), or a “hole” in the heart, is a condition that may increase the risk of stroke or transient ischemic attack (TIA).
Sometimes when a person has a stroke or TIA without warning, without obvious risk factors, it may be caused by a PFO.
About 1 in 5 Americans has a PFO, and there may be no symptoms.
While all people have flap-like openings in their hearts, for most people, these close shortly after birth. In some people, an open flap, the PFO, may remain.
This can allow a blood clot to travel through that flap and into the brain, causing a stroke.
Diagnosis and Testing
An ultrasound of the heart (echocardiogram) will show your doctor if you have a PFO.
Once diagnosed, your doctor will discuss treatment options with you.
There are two main treatments for PFO: medicines or surgery.
Medicines don’t actually treat PFO, but they can control blood clotting, which may help reduce the risk of stroke.
Traditional open-heart surgery may (rarely) be used for patients with PFO who are not responsive to medication.
However, there are newer approaches, such as an implanted closure device. This implant looks like a tiny umbrella with two ends, which is delivered to the PFO by means of a tiny tube (catheter) threaded to the head from a vein in the thigh.
Once reaching the PFO, the implant is inserted in the flap and is released. As it expands, tissue then grows in and around it, sealing the PFO from both sides.
Currently, the FDA only allows this procedure in patients who haven’t responded to medication and who have already had a second stroke.
Studies are ongoing as to whether the implanted closure device is better than drugs in helping reduce risk of recurrent stroke in patients who have had a stroke or a TIA.