The foramen ovale is an opening in the heart’s interatrial septum. It’s meant to close soon after birth. But, in about 25% of adults, this closure doesn’t happen, creating what’s known as a patent foramen ovale (PFO). A PFO can lead to cryptogenic strokes. This happens when a clot from a vein travels to the brain through the PFO.
The decision on whether to close a PFO is debatable. Most guidelines suggest starting with medical treatments. But, some procedures, like percutaneous PFO closure, seem to work better. These use special devices to close the hole. Yet, after many studies, it’s still not clear if this procedure is the best option.
Key Takeaways:
- The foramen ovale is a congenital opening in the interatrial septum of the heart.
- In approximately 25% of adults, the foramen ovale remains open, known as a patent foramen ovale (PFO).
- PFO has been implicated as a cause of cryptogenic strokes.
- Percutaneous PFO closure using devices designed for atrial septal closure has shown superiority to medical therapy in nonrandomized clinical trials.
- Randomized trials have debated the superiority of PFO closure over medical therapy.
Diagnosis and Treatment of Patent Foramen Ovale (PFO)
Diagnosing and treating PFO requires different tests and steps. These help check for PFO, see how bad the symptoms are, and choose the right treatment.
Diagnosis of PFO
A PFO is often found during tests for other heart problems. Echocardiography gives a clear heart image and shows the PFO hole.
Sometimes, a bubble study might be done. It involves injecting saline into a vein. If bubbles reach the left atrium, it shows there’s a PFO.
Treatment Options
Whether to treat a PFO depends on the symptoms and risks. Some people with PFO don’t need treatment if they’re not having problems.
Treatment can include taking blood thinners. These medicines stop clots from causing issues. Aspirin or other drugs may be used, depending on what the doctor suggests.
Another common treatment is to close the PFO hole with a special device. This device stays in the heart, letting the tissue grow over it.
Surgery might be an option for some, usually done if they’re already having heart surgery for other reasons. But this is rare.
The right treatment for a PFO depends on the person’s health and symptoms. Always talk to a doctor to decide what’s best for you.
| Treatment Options for PFO | Advantages | Disadvantages |
|---|---|---|
| Antiplatelet Therapy | – Non-invasive – Lower risk of complications |
– May not completely prevent recurrent events – Potential side effects of medications |
| Transcatheter Intervention | – Minimally invasive – High success rate in closing PFO |
– Procedure-related risks – Potential need for long-term medication |
| Surgical Closure | – Effective for severe cases – Can be performed during other cardiac surgeries |
– Higher risk of complications – Longer recovery time |
Think carefully about closing a PFO, weighing up the risks and benefits, with your healthcare provider’s advice.
Conclusion
The foramen ovale is crucial in fetal development and closes after birth. But, for some, it stays open, causing a patent foramen ovale (PFO). People with a PFO usually don’t show any signs and symptoms. Yet, they face a higher risk of stroke, heart attack, and migraine with aura.
Deciding on closing a PFO involves looking at symptoms and risk factors. A treatment called transcatheter intervention used to close the PFO with a device can lower the risk of more strokes for certain patients.
However, not everyone with a PFO needs it closed. For treatment, doctors consider each person’s situation. More studies are necessary to fully understand if PFO closure is the best way to manage foramen ovale disease.