Patent foramen ovale (PFO) in the heart: what it is and how to diagnose it
The patent foramen ovale is a congenital heart anomaly that affects 1 in 4 people and does not normally cause any problems, but in some cases can lead to cerebral ischaemia: it is the patent foramen ovale
What is a patent foramen ovale?
The foramen ovale pervio, better known as PFO (Patent Foramen Ovalis), is an anatomical variant at the level of the interatrial septum.
A kind of window is left open between the right and left atria of the heart, which should normally close after childhood.
Normally, this does not cause any problems, except when microthrombi present in the venous system pass through and reach the arterial system through this open passage.
Potential consequences of a patent foramen ovale
If microthrombi do pass through, there is a risk of:
- Ischaemic brain damage;
- peripheral injuries to the limbs, ears, eyes and other organs.
This is quite rare.
A pervious orifice is present in 25% of the population, in 86% of cases it does not cause any problems and in only 14% of cases you may experience ischemic brain or peripheral lesions, fainting or a major headache even as a child.
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Patent foramen ovale – the diagnosis
It is not easy to diagnose a patent foramen ovale except after an ischaemic event.
This congenital anomaly is rarely evaluated: ultrasound of the heart does not show a PFO.
Only the echocardiogram with saline contrast, known as the bubble test, can show the passage of sonicated (shaken) saline, i.e. saline water shaken in a syringe, from the right to the left sections of the heart and thus highlight this small defect.
The other method used to understand if there is a shunt, a passage between the two atria of the heart, is the transcranial Doppler.
This second test can confirm whether micro embolic signals are arriving in the brain by passing from the venous to the arterial system, but without specifying the location.
Symptoms
In the presence of a patent foramen ovale there are no symptoms except when ischaemic lesions occur.
At that point, an MRI scan is performed to detect micro lesions in the brain.
The operation to close the patent foramen ovale
To prevent blood clots from reaching the brain through the PFO, this passage can be closed with a device, a sort of umbrella that is placed between the two cardiac atria to close the passage.
However, this operation is only performed after an ischaemic episode.
Sports at risk?
The patent foramen ovale does not contraindicate any sport, except in the case of diving.
Divers, in fact, have a risk of up to 5 times greater of having decompression sickness from gas embolism and consequently peripheral or cerebral microinjuries.
PFO can therefore be a limiting factor.
However, it must be said that it is not compulsory to look for it, so many divers obtain fitness without knowing that they have it and run the risk of injury.
The advice for divers is to first undergo a saline contrast echocardiogram to see if they have a severe PFO or not.
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