Most people with a patent foramen ovale don't need treatment. In certain circumstances, however, your doctor may recommend that you or your child have a procedure to close the patent foramen ovale.
Reasons for closure
If a patent foramen ovale is found when an echocardiogram is done for other reasons, a procedure to close the opening usually isn't performed. Procedures to close the opening in the heart may be used in the following circumstances:
- If your child is undergoing surgery to correct a congenital heart defect and your child also has a patent foramen ovale, the surgeon may close the opening when making other repairs to the heart.
- In adults having other types of heart surgery, a patent foramen ovale may be closed at the time of the operation.
- Closure of a patent foramen ovale may be done to treat low blood oxygen levels linked to the patent foramen ovale.
Closure of a patent foramen ovale to prevent migraines isn't currently recommended. Closure of a patent formaen ovale to prevent a stroke remains controversial. Closure may be recommended for individuals with recurrent strokes despite medical therapy, when no other cause has been found.
Surgical and other procedures for closure Procedures to close patent foramen ovale include:
- Device closure. Using cardiac catheterization, doctors can insert a device that plugs the patent foramen ovale. In this procedure, the device is on the end of a long flexible tube (catheter). The doctor inserts the device-tipped catheter into a vein in the groin and guides the device into place with the imaging assistance of an echocardiogram. Although complications are uncommon with this procedure, a tear of the heart or blood vessels, dislodgement of the device, or the development of irregular heartbeats may occur.
- Surgical repair. A surgeon can close the patent foramen ovale by opening up the heart and stitching shut the flap-like opening. This can sometimes be done with the use of robotic techniques and a very small incision. If you or your child is undergoing surgery to correct another heart problem, your doctor may recommend that you have the patent foramen ovale corrected surgically at the same time.
Medications can be used to try to reduce the risk of blood clots crossing a patent foramen ovale. Anti-platelet therapy such as aspirin or clopidogrel (Plavix) and other blood thinners, such as warfarin (Coumadin, Jantoven), dabigatran etexilate (Pradaxa) and rivaroxaban (Xarelto), may be helpful for people with a patent foramen ovale who've had a stroke. It's not clear whether medications or invasive procedures to close the defect are best for stroke prevention in people with a patent formen ovale, and studies are ongoing to answer this question.
Nov. 01, 2012
- Kutty S, et al. Patent foramen ovale. The known and the to be known. Journal of the American College of Cardiology. 2012;59:1665.
- McPhee SJ, et al. Current Medical Diagnosis & Treatment 2012. 51st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=3671. Accessed Aug. 9, 2012.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 15, 2012.
- Bucholz S, et al. Diagnosis and management of patent foramen ovale. Postgraduate Medical Journal. 2012;88:217.
- Hara H, et al. Patent foramen ovale. http://www.uptodate.com/index. Accessed Aug. 14, 2012.
- Furie KL, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack. Stroke. 2010;42:227. Accessed Aug. 12, 2012.
- Furlan AJ, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. New England Journal of Medicine. 2012;366:991.
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