Learning you have a hole in your heart seems like something you should be worried about. But this heart condition — known as patent foramen ovale or PFO — is very common. Many people who have it don’t know it or have any symptoms. The problem is that for some people, this condition puts them at risk of a stroke.
In this video, Matthew Price, MD, an interventional cardiologist at Scripps Clinic, joins San Diego Health host Susan Taylor to discuss what causes PFO, why it puts some people at risk for heart problems and new medical treatments used to close the PFO in the heart and reduce the risk of stroke and heart attack.
“PFO closure is a really important option for patients who know they have something that's putting them at risk for having a stroke and that can be treated definitively so that it never has to threaten them again,” Dr. Price says.
Foramen ovale is the name of the small opening in the upper chambers of the heart that everyone is born with and plays an important role in our development when we are still in the womb.
“When we are in utero in our mother's womb, there's actually a connection — a hole between the right and left atrium — that allows blood to come from the placenta into the system of the newborn, and that's called the foramen ovale, or the oval hole,” Dr. Price says.
This hole normally closes soon after birth. “But in about one out of four people, it stays open, and the name for that is patent foramen ovale or a PFO,” Dr. Price explains.
The vast majority of people with PFO never know they have it or need treatment, even though blood is leaking from the right atrium to the left. PFO is most commonly found during tests for heart-related problems, such as atrial fibrillation.
To be clear, PFO doesn’t actually cause stroke. But in some people, it can create a way for a blood clot to travel to the brain and cause a stroke.
“We believe that the PFO — this hole between the right and left side of the heart — can act as a conduit for blood clots that can form in the leg and travel to the brain,” Dr. Price says.
A cryptogenic stroke is a stroke without a known cause. PFO is often a contributing factor in unexplained strokes, Dr. Price says. “In about 30 to 50 percent of those patients who have a cryptogenic stroke, we uncover a PFO,” he says.
While special drugs can prevent blood clots, they do not close the hole. In recent years, new devices have been introduced that close the PFO using minimally invasive techniques.
“If you have a hole in your heart where we think blood clots can travel through from one side of the heart to the other and cause a stroke, it makes sense to close the hole, and prevent that from happening,” Dr. Price says.
“This is not open heart surgery,” Dr. Price says, about new catheter-based treatments for PFO. “Over the last decade, several devices have been developed that we can implant using a very small catheter,” he says.
A catheter is a long, thin, flexible, hollow tube that is inserted into a vein, usually in the groin area, with a small incision and moved into the heart.
The Amplatzer PFO Occluder is a device approved by the U.S. Food and Drug Administration to close a PFO and prevent recurrent strokes in some patients.
The device — which consists of two expandable discs made from nitinol, an alloy of nickel and titanium — remains permanently in the heart and serves to stop blood flowing between the two atrial chambers of the heart.
“This device has been proven to reduce the risk of recurrent stroke in patients who have a cryptogenic stroke that we think is from a PFO,” Dr. Price says.
Another device that has been proven to be effective is the Cardioform Septal Occluder, which is also made from nitinol, he says.
While using blood-thinners is a common line of defense to prevent stroke in patients with PFO, closing the hole is an option for those who don’t want to deal with the side effects of blood thinners. “It's a daily medicine. And there's a risk of bleeding,” Dr. Price says about the medication. “It prevents blood clots from forming, which is great, but it's also bad if you have a propensity to have a bleeding problem.”
Dr. Price says there are few physical restrictions when it comes to living with a PFO closure device in your heart.
“As their physician, I don't recommend sky diving as a recreational activity. But some people do anyway,” he says. “So, really, very few restrictions.”