Patent Foramen Ovale (PFO)

Does your primary care doctor or neurologist suspect that you have a patent foramen ovale (PFO) that needs treatment?

It’s important to choose a team of heart specialists who can correctly detect and thoroughly evaluate a PFO. The state’s most experienced PFO experts are part of the team at University of Iowa Heart and Vascular Center.

PFOs that remain open are thought to cause strokes, migraines, and other problems. For many years, closing a PFO required open-heart surgery. Now, a minimally invasive cardiac catherization repair is the most frequent treatment, with outcomes comparable to open-heart surgery.

The UI Heart and Vascular Center interventional cardiology team has performed these closures for more than 20 years. As part of the clinical trials for today’s newest closure devices, we’ve helped to shape the field. And we offer the broadest range of treatment options for PFO and other heart conditions.

PFO symptoms and diagnosis

The foramen ovale is a small flap between the two upper chambers of the heart (left and right atria). This flap is present in every fetus, and should close naturally after the baby is born.

In 20 to 25% of people, the flap never closes completely: In medical terms, “patent” means “open.” PFOs don’t cause any problems for most people who have them.

Why would a PFO need to be closed?

It’s normal for tiny blood clots to form in our veins. These clots are filtered out by the lungs, which get their blood supply from the heart’s right atrium. The filtered, oxygen-rich blood from the lungs then enters the left atrium, and the left ventricle pumps it out to your body.

When blood clots pass through the right atrium into the left atrium, they are pumped out into the bloodstream and can reach the brain. This can cause a transient ischemic attack (TIA) or stroke.

Other medical problems that PFOs can cause include:

  • Migraine headaches
  • Decompression illness in divers
  • Low blood oxygen levels (hypoxemia), although this is rare

How we diagnose PFOs

Some PFOs are spotted during tests for other heart issues, like arrhythmia.

If you have severe migraines, or you’ve had a TIA or stroke without a known cause, you should be checked for a PFO.

Diagnostic tests might include:

PFO treatment at UI Health Care

Our team examines you and reviews your test results. They work together to determine whether you need a procedure to close your PFO.

Your care team may include:

If your team determines that you need open-heart surgery for another heart problem, such as a valve replacement, your PFO could potentially be closed during surgery. PFO closure is rarely done as an open-heart surgery on its own.

Minimally invasive PFO closure

PFOs that need repair can usually be closed with a cardiac catheterization procedure to place a device that seals off the flap.

UI Heart and Vascular Center cardiologists were part of clinical trials to test devices for PFO closure, so they’re among the nation’s most experienced specialists.

  • You’ll receive a sedative to relax you, but you will remain awake during the procedure.
  • After numbing the skin with a local anesthetic, your cardiologist will make a small incision in a vein near your groin and insert a tube called a catheter into the incision.
  • Through the catheter, the cardiologist will thread a small PFO closure device into your heart and place it in the hole to seal it closed. Tissue will eventually grow over the device to further seal the flap.
  • You’ll likely be able to go home the same day and resume normal activities within two weeks. Your risk of stroke decreases.

Alternatives to PFO closure

Your care team will choose the treatment that works best for you. They might recommend treating your PFO with medication to prevent blood clots from forming. Medications could include:

  • Aspirin or another antiplatelet drug that makes your blood cells less likely to stick together
  • A blood thinner (anticoagulant) that limits the formation of factors that make blood clot

Has your doctor referred you for PFO evaluation?

We'll connect you with a highly trained specialist who has extensive experience treating PFOs.

Care Team