It's normal to feel a little scared and anxious when your doctor tells you, "You have a small hole in your heart." But you really don't need to worry about this. Because this condition called PFO that we're talking about today affects only one in four people in the world, and most of the time it's harmless. So let's get to know it better.
Simply put, what is this PFO?
The full name of PFO is Patent Foramen Ovale . Simply put, this is a small hole between the two upper chambers of our heart (which we call the atria) that remains unclosed after birth.
Now you might be thinking, "Oh, I have a hole in my heart?" But the truth is: We all have this hole in our brain when we're in the womb. We call it the 'Foramen Ovale.' This is important.
What is this hole in the womb for?
Think about it, a baby doesn't breathe through its lungs when it's in its mother's womb. The baby gets the oxygen-rich blood it needs from the mother through the umbilical cord. So when this oxygen-rich blood reaches the heart, it doesn't go to the lungs, but instead goes straight from the upper right chamber of the heart to the upper left chamber , which is called the 'Foramen Ovale'. That's where the blood goes to the baby's brain and the rest of the body.
Once the baby is born and takes its first breath, the lungs start working. Then there's no need for that shortcut. So this hole usually closes on its own, often before the baby is 3 years old.
The word 'Patent' means 'open'. So 'Patent Foramen Ovale' (PFO) means that the hole is open without closing.
How does a PFO affect my body?
Many people (about 1 in 4 people) have this PFO, but it doesn't cause any symptoms or problems. They live normal lives without even knowing they have it.
However, very rarely, this can be a problem for some people. Do you know how?
Sometimes small blood clots can form in the deep veins of our bodies, especially in our legs. We call this deep vein thrombosis (DVT) . Normally, if a blood clot breaks loose and travels to the heart, it is sent from the heart to the lungs. Our lungs act like a filter , catching these blood clots and dissolving them.
But in someone with a PFO hole, this blood clot can 'jump' from the right side of the heart to the left side, through that hole. If that happens, the blood clot can bypass the filter in the lungs and go straight to the brain, kidneys, or anywhere else in the body.
If it travels to the brain and gets stuck in a small artery, it can cause an ischemic stroke . This is the main risk associated with a PFO.
Who is most likely to be diagnosed with a PFO?
Anyone can have a PFO, but it's usually discovered incidentally during testing for another reason. People in these groups are especially likely to be diagnosed with a PFO:
- People with cryptogenic strokes: If a stroke occurs in someone under the age of 60 and no clear cause can be found, doctors will check for a PFO, as about one in two people with this condition may have one.
- Divers: When divers ascend rapidly, the pressure changes can cause air bubbles to form in the blood. These bubbles can travel through the PFO into the brain, causing problems.
- Mountain climbers: It is believed that having a PFO may contribute to some of the conditions that occur at high altitudes.
What are the symptoms of PFO?
As mentioned earlier, the majority of people do not have any symptoms.
But very rarely, if the hole is a little larger or if it is combined with other heart conditions, some symptoms may appear.
- Decreased oxygen levels in the blood.
- Headaches such as migraine.
- Difficulty breathing while sitting or standing (platypnea-orthodeoxia syndrome).
- Symptoms of decreased blood flow to the body's limbs or organs such as the kidneys.
But remember, a PFO is often discovered after someone has had a stroke , transient ischemic attack (TIA) , or heart attack , while trying to determine the cause.
How do doctors detect a PFO?
There are several tests to determine exactly whether a PFO is present.
1. Listening with a stethoscope: Sometimes, when a doctor listens to your heart, they may hear an unusual sound (murmur) as blood flows through the PFO. But this is not very common.
2. Echocardiogram: This is the main and best way to diagnose a PFO. It is like a scan of the heart. There are two main types.
- Transthoracic echocardiogram (TTE): This involves applying a gel to the surface of your chest and placing a probe-like device on it to take images of your heart.
- Transesophageal echocardiogram (TEE): This can produce clearer images of the heart. A small probe on a thin tube is inserted through the mouth, down the esophagus, and positioned just behind the heart. You will be given a light anesthetic before the procedure, so you will not feel any discomfort.
3. Bubble Test: This can be done at the same time as the echo. This involves shaking up a small amount of saline solution until it bubbles up and then injecting it into your vein. If you have a PFO, the saline bubble will be clearly visible on the echo scan as it passes through the hole to the other side of the heart.
Does a PFO need treatment?
This is the most important thing. Most people don't need any treatment. Even if they have a PFO, if it's not causing any risk, the doctor will tell them not to even think about it.
However, if you have had a previous stroke and think the cause is the PFO, or if you are at high risk of developing blood clots, your doctor may recommend treatment.
Treatment methods can be divided into several main parts.
| Treatment method | Simple explanation |
|---|---|
| Medications | This involves giving blood-thinning medications (anticoagulants). Examples include aspirin , clopidogrel , or warfarin . These reduce the risk of blood clots. |
| Endovascular Surgery | This is the most common way to close the hole. It doesn't require major surgery. A thin tube (catheter) is inserted through a large vein in the leg or arm and guided all the way to the heart. Then, a small device is passed through the tube and the PFO hole is closed on both sides. This is like closing the hole with two umbrellas. |
| Heart Surgery | This procedure may be used when the above methods are not possible, or during other heart surgery. It can be an open-heart surgery or a small incision surgery. However, it is very rare to have to perform such a major surgery just to close a PFO. |
Your doctor will examine your condition and decide which treatment method is best for you.
Are there any complications in the treatment?
As with any medical treatment, there are some very small risks associated with these treatments. However, they are very rare. Bleeding, abnormal heart rhythms (atrial fibrillation), and infections can occur. However, these risks are very small compared to the benefits of the treatment.
What will my future be like with a PFO?
The answer to this is very simple and reassuring: very good!
Many people live normal, healthy lives without even knowing they have a PFO. Even if treatment is needed, especially after surgery to close the hole, the results are very successful. Many people make a full recovery, go about their daily lives without any problems, and live full lives.
If a newborn baby is told they have a PFO, don't worry about it. Most of the time, it will close on its own as they get older.
Take-Home Message
- PFO (Patent Foramen Ovale) is a small hole between the two upper chambers of the heart that does not close after birth. This is a very common condition.
- We all have this hole when we are in the womb. It is essential for the baby's blood circulation.
- Most people do not experience any symptoms or health problems due to a PFO.
- The main risk is that a blood clot that forms in the body could travel through this hole to the brain and cause a stroke. But this is rare.
- Most people do not need any treatment. Treatment is only needed for those at high risk of stroke.
- If you are diagnosed with a PFO, don't panic and talk openly with your doctor. He or she will provide you with all the information and guidance you need.
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