A patent foramen ovale (PFO) is a hole in the heart that didn't close the way it should after birth.
During fetal development, a small flap-like opening — the foramen ovale (foh-RAY-mun oh-VAY-lee) — is normally present in the wall between the right and left upper chambers of the heart (atria). It normally closes during infancy. When the foramen ovale doesn't close, it's called a patent foramen ovale.
Patent foramen ovale occurs in about 25 percent of the normal population, but most people with the condition never know they have it. A patent foramen ovale is often discovered during tests for other problems. Learning that you have a patent foramen ovale is understandably concerning, but most people never need treatment for this disorder.
Most people with a patent foramen ovale don't know they have it, because it's usually a hidden condition that doesn't create signs or symptoms.
Chambers and valves of the heart
A normal heart has two upper (receiving) and two lower (pumping) chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart. The heart valves, which keep blood flowing in the correct direction, are gates at the chamber openings (for the tricuspid and mitral valves) and exits (for the pulmonary and aortic valves).
It's unclear what causes the foramen ovale to stay open in some people, though genetics may play a role.
An overview of normal heart function in a child or adult is helpful in understanding the role of the foramen ovale before birth.
Normal heart function after birth
Your heart has four pumping chambers that circulate your blood:
- The right atrium. The upper right chamber (right atrium) receives oxygen-poor blood from your body and pumps it into the right ventricle through the tricuspid valve.
- The right ventricle. The lower right chamber (right ventricle) pumps the blood through a large vessel called the pulmonary artery and into the lungs, where the blood is resupplied with oxygen and carbon dioxide is removed from the blood. The blood is pumped through the pulmonary valve, which closes when the right ventricle relaxes between beats.
- The left atrium. The upper left chamber (left atrium) receives the oxygen-rich blood from the lungs through the pulmonary veins and pumps it into the left ventricle through the mitral valve.
- The left ventricle. The lower left chamber (left ventricle) pumps the oxygen-rich blood through a large vessel called the aorta and on to the rest of the body. The blood passes through the aortic valve, which also closes when the left ventricle relaxes.
Baby's heart in the womb
Because a baby in the womb isn't breathing, the lungs aren't functioning yet. That means there's no need to pump blood to the lungs. At this stage, it's more efficient for blood to bypass the lungs and use a different route to circulate oxygen-rich blood from the mother to the baby's body.
The umbilical cord delivers oxygen-rich blood to the baby's right atrium. Most of this blood travels through the foramen ovale and into the left atrium. From there the blood goes to the left ventricle, which pumps it throughout the body. Blood also travels from the right atrium to the right ventricle, which also pumps blood to the body via another bypass system.
Newborn baby's heart
When a baby's lungs begin functioning, the circulation of blood through the heart changes. Now the oxygen-rich blood comes from the lungs and enters the left atrium. At this point, blood circulation follows the normal circulatory route.
The pressure of the blood pumping through the heart usually forces the flap opening of the foramen ovale closed. In most people, the opening fuses shut, usually sometime during infancy.
Patent foramen ovale
A patent foramen ovale is a small, flap-like opening in the wall between the right and left upper chambers of the heart. It usually causes no signs or symptoms and rarely requires treatment.
Generally, a patent foramen ovale doesn't cause complications. But some studies have found the disorder is more common in people with certain conditions, such as unexplained strokes and migraines with aura.
In most cases, there are other reasons for these neurologic conditions, and it's just a coincidence the person also has a patent foramen ovale. However, in some cases, small blood clots in the heart may move through a patent foramen ovale, travel to the brain and cause a stroke.
The possible link between a patent foramen ovale and a stroke or migraine is controversial, and research studies are ongoing.
In rare cases a patent foramen ovale can cause a significant amount of blood to bypass the lungs, resulting in low blood oxygen levels (hypoxemia).
In decompression illness, which can occur in scuba diving, an air blood clot can travel through a patent foramen ovale.
In some cases, other heart defects may be present in addition to a patent foramen ovale.