Patent Foramen Ovale (PFO) Symptoms & Treatment

Advanced Heart Care to Lower Your Stroke Risk

Our team of heart and vascular providers at Baystate Health is the only one in the area that treats PFO. We’ve developed a team-based approach to caring for this condition that brings together experts from our neurology and heart and vascular departments to make sure you get the care you need for PFO.

What Causes Patent Foramen Ovale?

A patent foramen ovale (PFO) is a small hole between the heart’s upper two chambers, the right atrium and the left atrium. Everyone is born with a PFO, and it usually closes soon after birth. But PFOs don’t always close as they’re supposed to. There are no known risk factors for PFO, and the cause is not known.

PFO Symptoms

Most of the time, PFO does not cause noticeable symptoms. In fact, most people with this condition do not know they have PFO.

How We Diagnose a PFO

While PFO usually doesn’t cause any noticeable symptoms, it can be serious. PFO increases the risk of a stroke caused by deep-vein thrombosis (DVT), a blood clot that can form in the veins of the legs. Normally, the heart would pump this kind of blood clot into the lungs, which may cause shortness of breath but no stroke or other serious conditions. However, if you have a PFO, the clot can pass through the hole in your heart and travel to the brain, which can lead to a stroke.

You’ll work with our heart and vascular specialists as well as our neurology team as we test for what caused your stroke and if it could be the result of a PFO.

Testing for Conditions Other Than PFO

If you’ve had a stroke or similar conditions, such as a ministroke (a transient ischemic attack or TIA) or stroke-like syndrome (SLS), your neurologist or primary care doctor will order several tests to determine what caused it so you can lower your risk in the future. Many conditions can lead to a stroke, including:

• Atherosclerosis (a hardening of the arteries)
• Dissection (tearing) of an artery
• Inflammation of the blood vessels

As part of the testing process, you’ll likely need one or more of the following tests:

• Computed tomography (CT) angiogram (a test that uses X-rays to take pictures of the blood vessels in the neck and brain)
• Magnetic resonance imaging (MRI) angiogram (also called an MRA)
• Invasive angiogram (a surgical process in which we take pictures of the blood vessels in the neck and brain)
• Carotid duplex (an ultrasound test that measures how well blood flows through the carotid arteries, which carry blood to the brain)
• Blood tests to check for blood-clotting disorders, such as antiphospholipid antibody syndrome (APS), which can cause blood clots to form within veins and arteries
• Heart monitoring to check for certain heart disorders, such as atrial fibrillation (a type of arrhythmia or irregular heartbeat, left ventricular thrombus (a blood clot that can in the upper left chamber of the heart after a heart attack, or myxoma (tumors in the heart)

Testing for PFO

If none of these tests find evidence of conditions that may have caused your stroke, it may be the result of a PFO. We’ll then conduct a test called an echocardiogram with a bubble study, which uses ultrasound so we can see inside your heart. During this test, we’ll inject air bubbles into an intravenous (IV) line inserted into your vein. These bubbles will enter the right side of your heart, which we’ll watch on the echocardiogram. Normally, the heart will pump these bubbles safely into the lungs. However, if you have a PFO, these bubbles can travel into the left side of the heart.

If your bubble study shows that you could have a PFO, we’ll conduct a transesophageal echocardiogram (TEE) to view the hole in your heart. During this test, we’ll place an echocardiogram probe down your throat to take pictures of your heart. This lets us know whether you have a PFO or some other condition that would allow blood to travel from one side of the heart to the other, such as an atrial septal defect (a different kind of hole in the heart) or an arteriovenous malformation (an abnormal connection of blood vessels that, in this case, affects blood flow between the heart and lungs).

If we find that you do have a PFO, we then use a calculation called a risk of paradoxical embolism (RoPE) score to determine how likely it is your stroke was the result of your PFO. You can take an online test to determine your RoPE score at the MDCalc website. If you have a RoPE score of 3 or higher out of 10, you likely are a good candidate for PFO closure surgery.

Our Minimally Invasive PFO Surgery

On the day of your surgery, we’ll give you medications through an IV to make you sleepy but still able to respond to requests (conscious sedation). We will clean your groin area and place a thin, flexible tube called a catheter into a vein in your groin. This catheter contains an ultrasound camera, which lets us see inside your heart.

Next, your surgeon will insert a PFO closure device through your vein and into the PFO in your heart. This device will stay inside the PFO. We’ll remove the catheter, close the incision in your vein, and let you recover for a few hours. You likely will be able to go home the same day of your procedure.

After Your PFO Surgery

You should be able to resume your normal activities within two weeks after your procedure. Your doctor will prescribe aspirin and clopidogrel (Plavix) to reduce your risk for blood clots during this time. About six weeks afterward, we’ll need to take more ultrasounds of your heart and perform another bubble study to make sure your PFO has closed. At this point, the heart should be healing and sealing over the PFO closure device.

Once your PFO has fully closed over, you likely will be able to stop taking clopidogrel, though you will need to keep taking aspirin on an ongoing basis to reduce your risk for a future stroke. Your doctor will also prescribe antibiotics anytime you need any medical or dental procedures for up to a year after your procedure to reduce your risk for an infection at your PFO closure site.