Professional Documents
Culture Documents
The septum is the muscular wall separating the heart into the left and right sides.
The atrial septum is the wall separating the atria (the two upper chambers).
The ventricular septum is the wall separating the ventricles (the two lower chambers).
The foramen ovale is a small hole located in the atrial septum that is used during fetal circulation to speed up the
Symptoms of PFO
Most patients do not have any symptoms with PFO.
weakness or numbness of the face, arm or leg on one side of the body
loss of vision or dimming (like a curtain falling) in one or both eyes
loss of speech, difficulty talking or understanding what others are saying
sudden, severe headache with no known cause
loss of balance, unstable walking, usually combined with another symptom
Learn more about stroke
Diagnosis of PFO
Patent Foramen Ovale can be detected by echocardiogram. In some cases the patient is asked to cough or
perform the Valsalva maneuver to increase pressure in the right atrium. This can increase the flow of blood from
the right to left atrium. Transesophageal echo, can provide a closer and more detailed view of the PFO.
PFO Repair
It is not clear what the best treatment is for PFOs discovered during routine clinical imaging. Research is still
being done. No scientific studies have shown the benefit of taking primary preventive measures to prevent stroke
in patients with PFO.
A person with PFO who already has had a stroke may have a higher risk of future strokes, depending on factors
such as the degree of shunting and the presence of another defect known as an atrial septal aneurysm (a
"floppy" atrial septum). Therapy recommendations for these patients continue to be investigated and may include
anticoagulant therapy (blood thinners) such as aspirin, clopidogrel or warfarin; surgery to close the defect; or a
percutaneous closure device. The risks and long-term benefits of using percutaneous occlusion devices to treat
patients with PFO are not yet determined. This type of treatment generally is recommended only for patients
taking medication to reduce their risk of blood clots who have a second stroke or transient ischemic attack (TIA,
or "mini stroke") thought to be caused by PFO.
AMPLATZER device used for PFO repair. Photo used with permission from AGA Medical Corporation*
The closure devices commonly used for percutaneous PFO repair include the Amplatzer PFO Occluder, the
GORE HELEX Occluder and the STARflex Septal Repair Implant.
GORE HELEX Septal Occluder used for PFO repair. Photo used with permission from W.L. Gore & Associates, Inc.
The GORE HELEX Septal Occluder is a transcatheter closure device used to treat PFO. It is a disc-like device
that consists of ePTFE patch material supported by a single Nitinol wire frame.
The device is folded into a special catheter and inserted into a vein in the leg. Using a guide wire, the device is
advanced through the atrial septum.
When the catheter is in the correct position, the device slowly is pushed out of the catheter until it covers and
bridges the defect. Over time, heart tissue grows over the implant, and it becomes part of the heart, correcting
the defect.
Patients with a patent foramen ovale are not at an increased risk of endocarditis and antibiotic prophylaxis is not
indicated. For those who have had their PFO closed with a transcatheter device, endocarditis prevention is
recommended for at least 6 months following the device implant. According to the American Heart Association,
after 6 months, there is insufficient data to make recommendations for prophylactic therapy. If your PFO has been
repaired, ask your physician if you require continued bacterial endocarditis prevention. (Prevention of Endocarditis,
AHA Recommendations, Circulation. 1997;96:358-366)
Your doctor will tell you how often to make appointments for follow-up.