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    4. Patent foramen ovale (PFO)

    Patent foramen ovale (PFO)

    At Mayo Clinic Healthcare, our cardiology consultants provide expert assessment and treatment for patients with a patent foramen ovale (PFO). The condition leaves a flap-like hole between the two upper heart chambers after birth.

    While many people live with this condition without symptoms, some may benefit from a personalised evaluation to determine whether a PFO closure is appropriate.

    We use advanced diagnostic imaging and a collaborative, patient-centred approach to understand your individual risk factors and health history. If treatment is recommended, our specialists will explain the available options, including minimally invasive techniques, and guide you through every step of your PFO closure procedure.

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    • A patent foramen ovale (PFO) is a small opening between the upper chambers of your heart that doesn’t close after birth. Most people don’t need treatment, and there is no clear reason why PFOs develop. In some cases, your specialist may recommend a procedure to close the opening, known as PFO closure.

    • If you have a PFO and no symptoms, you can usually continue your normal activities. If you'll be travelling long distances, you can prevent blood clots in a few ways:

      ●     Take breaks when driving or sitting down for long periods of time

      ●     Drink plenty of fluids

      ●     Walk around when possible

    • Most people with a PFO never have symptoms, and it is only discovered during tests for other health problems. However, in rare cases, symptoms may occur. These may be:

      ●     Low blood oxygen: In rare situations, blood may bypass the lungs, leading to lower oxygen levels, a condition called hypoxaemia. 

      ●     PFO and stroke risk: A small blood clot may pass through the PFO to the left side of the heart and then travel to the brain, where it can block blood flow and cause an ischaemic stroke.

      Research has found that people with unexplained strokes or migraines with aura may have PFOs more often, but the connection is uncertain and often coincidental.

    • Usually, a patent foramen ovale is discovered and diagnosed when tests are done for another health concern. If your healthcare provider thinks you may have a PFO, we may perform one or more of our cardiology diagnostic tests to assess the condition.

      If you have a patent foramen ovale and have had a stroke, your provider may refer you to a neurologist - a consultant trained in matters of the brain and nervous system. 

    • Mayo Clinic Healthcare specialists can perform a variety of tests to understand the exact nature of your PFO. They use mainly an echocardiogram, a test that uses sound waves to create moving images of the heart. It shows the heart’s structure and how blood flows through its chambers and valves.

      And because we house the necessary tests, you can receive results usually within a few days of visiting the clinic.

      Your care team may use several tests to find a PFO. These range from standard to more detailed imaging tests and will be recommended based on your personal needs and preferences.

      Standard imaging tests include:

      ●     A colour Doppler: This technique shows changes in blood flow using colour. It may reveal blood moving between the upper chambers if a PFO is present.

      ●     Saline contrast (bubble) study: During this test, a salt-water mixture with tiny bubbles is injected into a vein. If the bubbles appear in the left side of the heart, they may have passed through a PFO.

      More detailed imaging tests may include:

      ●     A transthoracic echocardiogram: This common type of echocardiogram takes images from outside the chest. A device called a transducer sends sound waves into the body, and a computer turns the returning echoes into pictures.

      ●     A transesophageal echocardiogram: A thin tube with an ultrasound probe is inserted down the throat into the oesophagus to take detailed images from close to the heart. This method provides a very accurate view of a PFO.

    • In most cases, a patent foramen ovale does not require treatment. However, if treatment is needed, your consultant may recommend medication or a closure procedure, performed either through surgery or via catheter.

    • A PFO closure procedure is normally only performed when a patient is suffering from low oxygen levels or has suffered an unexplained stroke.

      Most people with a PFO do not need any treatment, especially if the opening is found by chance during another test. However, if your PFO requires treatment, your Mayo Clinic Healthcare specialist will work with you to tailor a plan to the exact type of PFO and health goals.

      Mayo Clinic Healthcare may provide medication management to address your PFO. For instance, blood-thinning medicines can lower the chance of clots crossing the PFO, which is particularly important for people who have had a stroke.

      To ensure you get the exact care you need, your Mayo Clinic Healthcare consultant may refer you to a trusted health professional for advanced procedures, such as:

      ●     Device closure: where your doctor guides a thin tube through into a blood vessel in the groin area to close the opening. This method is similar to an ASD closure procedure, which treats a different type of heart opening. Complications are uncommon but can include tears, movement of the device or irregular heart rhythms.

      ●     Surgical closure:  A surgeon closes the PFO with stitches. This may be performed during heart surgery and can involve robotic tools. If heart surgery is already planned for another reason, a PFO closure procedure at the same time may be recommended.

      Your care team will discuss and decide with you which of these will have the best outcome for your individual needs.

    Private health insurance

    Mayo Clinic Healthcare works with all major private health insurance providers, including AXA PPP, Aviva, BUPA, Health Partners Group, Vitality Health and WPA. Self-pay arrangements are also available.

    Book your appointment

    If you're experiencing symptoms from a PFO or want a second opinion, contact us today. Our experienced PFO specialists near you can help by providing expert PFO care.

    Request an appointment online or call us at +44 (0) 207 871 2575.

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    4. Patent foramen ovale (PFO)