Patent foramen ovale
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A patent foramen ovale (PFO) is a hole in the heart that didn’t close the way it should after birth.
During fetal development, a small flap-like opening — the foramen ovale (foh-RAY-mun oh-VAY-lee) — is normally present in the wall between the right and left upper chambers of the heart (atria). It normally closes during infancy. When the foramen ovale doesn’t close, it’s called a patent foramen ovale.
Patent foramen ovale occurs in about 25 percent of the normal population, but most people with the condition never know they have it. A patent foramen ovale is often discovered during tests for other problems. Learning that you have a patent foramen ovale is understandably concerning, but most people never need treatment for this disorder.
Most people with a patent foramen ovale don’t know they have it, because it’s usually a hidden condition that doesn’t create signs or symptoms.
A normal heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.
It’s unclear what causes the foramen ovale to stay open in some people, though genetics may play a role.
An overview of normal heart function in a child or adult is helpful in understanding the role of the foramen ovale before birth.
Your heart has four pumping chambers that circulate your blood:
Because a baby in the womb isn’t breathing, the lungs aren’t functioning yet. That means there’s no need to pump blood to the lungs. At this stage, it’s more efficient for blood to bypass the lungs and use a different route to circulate oxygen-rich blood from the mother to the baby’s body.
The umbilical cord delivers oxygen-rich blood to the baby’s right atrium. Most of this blood travels through the foramen ovale and into the left atrium. From there the blood goes to the left ventricle, which pumps it throughout the body. Blood also travels from the right atrium to the right ventricle, which also pumps blood to the body via another bypass system.
When a baby’s lungs begin functioning, the circulation of blood through the heart changes. Now the oxygen-rich blood comes from the lungs and enters the left atrium. At this point, blood circulation follows the normal circulatory route.
The pressure of the blood pumping through the heart usually forces the flap opening of the foramen ovale closed. In most people, the opening fuses shut, usually sometime during infancy.
A patent foramen ovale is a small, flap-like opening in the wall between the right and left upper chambers of the heart. It usually causes no signs or symptoms and rarely requires treatment.
Generally, a patent foramen ovale doesn’t cause complications. But some studies have found the disorder is more common in people with certain conditions, such as unexplained strokes and migraines with aura.
In most cases, there are other reasons for these neurologic conditions, and it’s just a coincidence the person also has a patent foramen ovale. However, in some cases, small blood clots in the heart may move through a patent foramen ovale, travel to the brain and cause a stroke.
The possible link between a patent foramen ovale and a stroke or migraine is controversial, and research studies are ongoing.
In rare cases a patent foramen ovale can cause a significant amount of blood to bypass the lungs, resulting in low blood oxygen levels (hypoxemia).
In decompression illness, which can occur in scuba diving, an air blood clot can travel through a patent foramen ovale.
In some cases, other heart defects may be present in addition to a patent foramen ovale.
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Patent foramen ovale
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