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 patent foramen ovale may be done in certain circumstances, such as 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 foramen ovale to prevent a stroke remains controversial.
In some cases, doctors may recommend closure of the patent foramen ovale in individuals who have had recurrent strokes despite medical therapy, when no other cause has been found.
Surgical and other procedures for closure
Procedures to close a 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 procedure can be conducted using a very small incision and may be performed using robotic techniques.
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. Research is ongoing to determine the benefits of closing the patent foramen ovale during heart surgery to correct another problem.
Medications can be used to try to reduce the risk of blood clots crossing a patent foramen ovale. Antiplatelet therapy such as aspirin or clopidogrel (Plavix) and other blood thinning medications (anticoagulants) — such as warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), apixaban (Eliquis) 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 procedures to close the defect are most appropriate for stroke prevention in people with a patent foramen ovale. Studies are ongoing to answer this question.
July 16, 2015
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