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Patent Foramen Ovale

Basic Facts

  • Patent foramen ovale (PFO) is a condition in which a small flap-like opening in the atrial septum, the muscular wall that separates the two upper heart chambers, fails to seal after birth.
  • PFO is a relatively common condition; 25 percent of people are born with PFO.
  • Although it rarely causes symptoms, PFO can lead to a heart attack or stroke by allowing blood clots to enter the bloodstream and lodge in a coronary artery or an artery in the brain.
  • Treatments for PFO that causes symptoms focus on prescribing anticlotting drugs or on sealing the opening through surgery or minimally invasive procedures.
Patent foramen ovale (PFO) is a flap-like opening in the atrial septum that allows blood to flow from the right side of the heart to the left side of the heart.

PFO typically only requires treatment if the patient is suspected of having a traveling blood clot called a paradoxical embolism. Treatment ranges from medications to surgical procedures.


PFO generally causes no symptoms, but they can include cyanosis.


The cause of PFO is unknown.


PFO is diagnosed using the following tests:
  • Echocardiography;
  • Transesophageal echocardiography;
  • Contrast echocardiography;
  • Duplex ultrasonography;
  • Cardiac catheterization; and
  • Transcranial Doppler.

Treatment for PFO is generally considered unnecessary unless paradoxical embolism occurs. In that case, physicians first use antithrombotic medication.

Open surgery or minimally invasive procedures are indicated when patients don't respond to medications.

In open surgery, the physician opens the chest to gain access to the heart. The physician can stitch the PFO closed or make a graft to close larger holes.

For minimally invasive procedures, the physician threads a catheter through an artery to the heart and places an occluder in the opening, which seals the opening.

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