Have you ever heard that your heart, or rather, between the two upper chambers of the heart, can have a small opening that can remain after birth? Many people are surprised to hear this. But it's true. This condition is called a `Patent Foramen Ovale` or `(PFO)`. Don't worry, we'll talk about it simply, in a way that you can understand.
What is PFO? Let's understand it simply
Simply put, a patent foramen ovale (PFO) is a small, lid-like opening between the two upper chambers of your heart, the right atrium and the left atrium. Now imagine that when we are all in our mother's womb, this opening, called the foramen ovale, is there. It is essential. But usually, it closes after we are born. A PFO is when it doesn't close after birth. The word "patent" means "open."
Most of the time, people with a PFO do not have any symptoms and do not need treatment. However, very rarely, certain problems, such as stroke, can be associated with a PFO.
Why is this foramen ovale important? What happens during infancy?
A baby in the womb, a fetus, does not use its lungs to get oxygen-rich blood. Instead, this oxygen-rich blood comes from the mother through the placenta, along the umbilical cord. This is what the foramen ovale does, directing the oxygen-rich blood from the umbilical cord from the baby's right atrium directly to the left atrium.
From there, that blood travels to the left side of the baby's heart, supplying oxygen to the baby's brain and other vital organs. Quite an amazing mechanism, isn't it?
After the baby is born, when he starts breathing on his own, the blood goes to the lungs to get oxygen. That's when this ``foramen ovale'' usually closes. Then the oxygenated blood goes to the left side of the heart, and from there it is pumped to the whole body.
Who can develop PFO? How common is it?
In fact, PFO can affect anyone, regardless of gender, race, or color. However, it is more common among certain groups:
- Divers, especially those who suffer from ``Decompression sickness - air embolism``, a condition in which air bubbles block blood vessels due to pressure changes.
- Among those who have had a stroke for which no exact cause can be found (cryptogenic stroke).
Worldwide, about one in four people (25%) may have a PFO. In addition, it has been found that between 30% and 40% of people who have had a stroke for no apparent reason have a PFO. However, this does not mean that everyone with a PFO will have a stroke. It is important to remember that.
Does having a PFO affect the body?
When you have a `PFO`, a small amount of blood flows from the right atrium to the left atrium through those little flaps. Normally, this doesn't happen because these flaps are closed.
Most of the time, a PFO does not cause any problems. However, sometimes a blood clot can travel from the right side of the heart to the left side of the heart through this PFO. If that happens, the heart can pump that blood clot to other parts of the body. Imagine, if that blood clot goes to the brain, the blood supply to the brain can be disrupted. That is when a condition called an ischemic stroke occurs. Also, this blood clot can damage other organs such as the kidneys and the heart.
Is there a specific reason why PFO develops?
Researchers still haven't figured out exactly what causes PFO. That is, it's not yet clear whether it's genetic, environmental, or something else.
What are the symptoms of a PFO? See if you have these too
Many people with a PFO do not show any symptoms. That's true. However, sometimes you may see things like this:
- Stroke.
- Transient Ischemic Attack (TIA) or mini-stroke . This can cause difficulty moving a limb, and can affect vital organs such as the brain, small intestine, large intestine (colon), or kidneys.
In addition, rare conditions include:
- Myocardial infarction.
- Decreased oxygen levels in the blood (Hypoxemia).
- Platypnea-orthodeoxia syndrome (PO syndrome): This is a condition in which the oxygen level in the blood decreases with difficulty breathing while sitting upright.
How do you find out if you have a PFO? What are the tests?
Your doctor will first ask you about your symptoms and perform a physical exam. If a PFO is suspected, they may recommend tests such as:
- Transthoracic echocardiogram : An echocardiogram (or echo) is a test that uses sound waves to produce images of the heart's chambers. The test is performed by placing an instrument on the surface of the chest.
- Transesophageal echocardiogram (TEE) : In this test, your doctor inserts a small camera-equipped tube into your esophagus. This can produce a clearer picture of the PFO than a regular echo.
- Transcranial Doppler (TCD) ultrasound : A TCD ultrasound uses sound waves to look at the blood flow to and within your brain. It can also help detect strokes caused by blood clots.
Along with these tests, your doctor may also suggest a ``bubble test.'' This involves injecting a saline solution into your vein. If these bubbles flow through the opening into the left side of your heart without filtering out the lungs, they can identify whether you may have a ``PFO.''
Is there a treatment for PFO? Does everyone need it?
Most people with a PFO do not need treatment. However, if you have a history of stroke or blood clots, or are at high risk for them, your doctor may recommend treatment. Treatment options for a PFO include:
- Medicines that prevent blood clotting : For example, aspirin or warfarin.
- Catheterization : In this procedure, an interventional cardiologist uses a long, thin tube (catheter) to close the valve. This catheter is passed through a large vein in the groin into the heart and a special device (closure device) is used to close the valve. Studies have found that this catheter procedure is more effective than surgery in treating PFOs in people under 60 years of age.
- Heart surgery : A surgeon makes an incision and stitches the flap closed. This may be done if the catheter method is not successful. This may be done through open-heart surgery or through a few small incisions in the chest called a minimally invasive robotically assisted patent foramen ovale repair.
Recent research has shown that in people with a PFO who have had an unexplained stroke, closing the PFO may help prevent future strokes. It's best to talk to your doctor about which treatment option is right for you.
Can treatments cause side effects?
Some people may experience complications from treatment for PFO. These complications vary depending on the treatment method:
Things that can happen with medication
When taking medications like Aspirin or Warfarin, the following can happen:
- Bleeding.
- Bleeding into the brain (Intracranial hemorrhage).
What can happen during catheter treatment?
Common complications of catheterization:
- Blood clots.
- Damage to blood vessels.
- The closure device has come loose.
- Heart infection or `endocarditis`.
- The `PFO` does not close properly.
- `Blood clot in the lungs (Pulmonary embolism)`.
Rare complications:
- Air embolism.
- Heartbeat irregularities (Arrhythmia).
- `Atrial fibrillation (Afib)`.
- Cardiac tamponade (fluid buildup around the heart).
Things that can happen with surgery
Surgery to close a PFO can cause complications such as:
- `Atrial fibrillation (Afib)`.
- Bleeding.
- Infections.
- Stroke.
Is there a way to reduce the risk of PFO formation?
There is really nothing you can do to reduce the risk of developing a PFO. It is not something we can control. However, if you have an unexplained stroke (cryptogenic stroke), it is important to get tested for this condition. Then, if necessary, you can get treatment quickly.
What is the health status of someone with a PFO? Is it something to be worried about?
In most cases, the lid of a child with a PFO closes completely within the first three years of life. Many people with a PFO live full, healthy lives without any problems as adults. So don't worry about it unnecessarily .
If I have a PFO, how can I take care of my health?
You can keep your heart healthy and reduce your risk of stroke by following these steps:
- Avoid using alcohol or other drugs.
- Eat a heart-healthy diet.
- Control high blood pressure (Hypertension) or high cholesterol levels.
- Maintain a healthy weight.
- Stop smoking and using tobacco products.
- Get proper treatment for other health conditions that increase your risk of stroke, such as atrial fibrillation (Afib).
Also, not staying in the same position for too long can reduce the risk of blood clots.
What are the best times to see a doctor?
If you have any of the symptoms of a stroke , see a doctor right away or call 911 (or your local emergency number). These symptoms may include:
- Difficulty speaking or understanding.
- Dizziness or loss of balance.
- Numbness or weakness in the face, arm, or leg.
- Difficulty seeing in one or both eyes.
- Sudden severe headache.
Take-Home Message
A patent foramen ovale (PFO) is a small opening in the heart between the right and left chambers of the heart. It affects about one in four people (25%) . Most of the time, a PFO doesn't cause any symptoms and doesn't require treatment. However, sometimes it can be a sign of a stroke or mini-stroke. If you have a history of strokes or blood clots, your doctor may recommend treatment. Treatment options include medication, catheterization, and surgery. The important thing is that most people with a PFO can live full, healthy lives. If you have any concerns, don't hesitate to talk to your doctor.
` PFO, patent foramen ovale, hole in the heart, stroke, blood clot, heart disease, foramen ovale
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