Patent Foramen Ovale

________________________________________________________________________

KEY POINTS

• The foramen ovale is a hole between the 2 upper chambers of the heart (the atria), normally present before birth. It closes in most children after birth. If the hole does not close all the way, it is called a patent foramen ovale (PFO).
• Most children with PFO do not need treatment. If your child has symptoms, he or she may need medicine or surgery.
• Ask your healthcare provider how to take care of your child at home, what symptoms or problems you should watch for, and what to do if your child has them.

________________________________________________________________________

What is a patent foramen ovale?

The foramen ovale is a hole between the 2 upper chambers of the heart (the atria).

The heart has 4 sections or chambers. The upper chambers are each called atria, and the lower chambers are called ventricles. The heart muscle squeezes to push blood through these 4 chambers, to the lungs, and to the rest of the body. Blood flows from the right atrium into the right ventricle, and the right ventricle pumps it to the lungs. As it passes through the lungs, the blood picks up oxygen and leaves behind carbon dioxide. Then the blood flows back to the heart and into the left atrium, and from there into the left ventricle. The left ventricle pumps the blood out to the rest of the body, with a small amount going to the heart muscle itself. The heart pushes blood out through the arteries and blood returns to the heart through the veins.

A foramen ovale is normally present before birth and closes in most children after birth. If the hole does not close all the way, it is called a patent foramen ovale (PFO).

What is the cause?

Before birth, a baby’s blood does not need to go through the lungs to pick up oxygen because the baby gets oxygen-rich blood from the mother. After birth, increased blood pressure on the left side of the heart normally forces a flap over the hole to seal it, so all the blood then travels from the right side of the heart to the lungs.

Sometimes the flap does not seal. When this happens, the foramen ovale may open at times, and less blood will get to the lungs to pick up oxygen.

It is not known why the flap seals after birth in most people but not everyone.

What are the symptoms?

A PFO usually does not cause any symptoms. In rare cases, a baby with PFO may turn blue when crying or straining to pass a bowel movement.

PFO can cause some problems in adults. For example:

• If you have problems with high blood pressure in your lungs, PFO may make shortness of breath much worse.
• Blood clots from another part of the body may pass through the hole and into the brain, which can cause a stroke.
• Migraine headaches are more common in people with PFO.

How is it diagnosed?

Your healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child may also have an echocardiogram, which uses sound waves (ultrasound) to show pictures of the heart and how well blood is flowing through it.

How is it treated?

Most children with PFO do not need treatment.

Your child may need blood thinners to lower the chance of blood clots that might cause a stroke.

The hole may need to be closed if your child is not getting enough oxygen from the lungs or to prevent a stroke. This may be done during:

• Heart catheterization (coronary angiogram), which uses a small tube called a catheter inserted into a blood vessel, contrast dye, and X-rays to look at the blood vessels and heart. The healthcare provider will use tools put through the catheter to repair the defect.
• Open heart surgery

How can I help take care of my child?

Your child should have regular checkups. Your child may need to have regular follow-up visits with a specialist in congenital heart disease.

Follow your child’s healthcare provider's instructions. Ask your provider:

• How and when you will get your child’s test results
• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all regular checkup appointments with your child's healthcare provider.