Patent Foramen Ovale
Patent Foraminal Ovale
Patent Foramen Ovale (PFO) is a small, flap-like opening between the left and right atria of the heart.
This opening typically closes soon after birth but remains open in about 25% of people (Royal Buckingham Hospital, 2025). Although most individuals with a PFO are asymptomatic, in some cases, it can contribute to health issues such as strokes, migraines, or transient ischemic attacks (TIAs)
In Australia, PFO is present in around one-quarter of the population. While most people with this condition experience no adverse health effects, studies have shown a potential link between PFO and unexplained strokes, especially in younger adults.
Research indicates that about 30-40% of cryptogenic stroke patients—those with no obvious cause—have a PFO (Cryptogenic Ischemic Stroke, 2025). This highlights the importance of identifying and managing PFO in individuals at risk of stroke, especially given the significant burden strokes place on Australia’s healthcare system.
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Things you want to know
PFO often goes unnoticed because many people do not exhibit symptoms. However, in some cases, symptoms may include:
- Unexplained stroke or TIA
- Migraine with aura
- Shortness of breath, especially during physical activity
- Fatigue
- Heart palpitations or skipped beats
PFO is a congenital condition, meaning it is present from birth. During fetal development, the foramen ovale helps blood bypass the lungs, which are not used until after birth. In most people, this opening closes shortly after birth. In cases where it remains open, it is referred to as a Patent Foramen Ovale. The exact reason why this opening remains in some individuals is not entirely understood, but it is generally considered a normal variant unless associated with other health concerns.
A PFO is often discovered during an investigation for other heart conditions, or after a stroke. The following tests are commonly used to diagnose PFO:
- Echocardiogram: An ultrasound of the heart that can visualise blood flow and detect the presence of a PFO.
- Bubble Study: A special echocardiogram where a saline solution is injected into the bloodstream. If bubbles pass from the right to the left atrium, it suggests a PFO.
- Transesophageal Echocardiogram (TEE): A more detailed type of echocardiogram where the probe is passed down the esophagus for clearer images.
- Cardiac CT Scan: In some cases, a CT scan may be used to better visualise the heart’s anatomy, particularly in combination with contrast dye.
While most individuals with PFO do not experience complications, certain risks are associated with the condition:
- Stroke: PFO can allow small blood clots to pass from the right to the left side of the heart and into the bloodstream, potentially causing a stroke.
- Migraine: Some studies suggest a link between PFO and migraines, particularly migraines with aura.
- Heart Attack: Rarely, PFO may contribute to heart attacks if clots or other materials pass through the opening and affect coronary circulation.
Treatment for PFO is not always necessary unless it leads to complications like stroke. In such cases, the following options may be considered:
- Medications: Blood-thinning medications, such as aspirin or anticoagulants, may be prescribed to reduce the risk of stroke.
- PFO Closure Procedure: A minimally invasive procedure using a catheter to insert a device that seals the PFO. This is typically recommended for individuals who have experienced strokes or recurrent TIAs without a clear cause.
- Surgery: In rare cases, open-heart surgery may be required, but this is less common due to the success of catheter-based procedures.
Commonly Asked Questions
Typically, a PFO does not close on its own after infancy. However, it may remain undetected for many years or even a lifetime if no complications arise.
No, closure is not recommended for everyone. It is generally only considered for patients who have had a stroke or recurrent TIAs with no other identifiable cause.
A PFO can allow small blood clots from the veins to bypass the lungs, where clots are typically filtered out and pass directly into the arterial system, where they can travel to the brain and cause a stroke.
PFO closure is a minimally invasive procedure and is generally considered safe, with a high success rate. As with any medical procedure, there are risks, but serious complications are rare.
By understanding PFO and its potential risks, individuals can work with their cardiologist to determine the most appropriate management and treatment strategies, particularly if stroke or other complications are a concern.
