Patent Foramen Ovale and Atrial Septal Defect

Patent foramen ovale (PFO) and atrial septal defect (ASD) are congenital (present-at-birth) conditions that affect the inter-atrial septum (tissue between the right and left upper chamber of the heart). PFO is a flap-like hole in the inter-atrial septum that can allow blood to go from the right to left chambers and could be a cause for stroke. ASD is a defect (hole) in the inter-atrial septum that typically allow blood to go from the left to right chambers and can lead to symptoms and reduced heart function.

PFOs are quite common, occurring in roughly one out of every four people. In most people treatment for the PFO is not required. However, if stroke related with the PFO is diagnosed, closure is recommended.

However, roughly one out of every 120 babies are born with some type of heart defect, and ASD is the most common type. Some ASDs close on their own and require no treatment, while other ASDs will need to be closed.

When treatment is needed, the cardiovascular specialists at the UF Health Cardiovascular Center can help. Our specialists, all faculty members of the University of Florida College of Medicine – Jacksonville, are experienced in treating and managing both of these conditions. Both conditions are treated with minimally-invasive catheter-based options.

Symptoms of Patent Foramen Ovale

Most people who have this condition do not experience symptoms or complications. However, PFO related symptoms and conditions include:

  • Blood clots
  • Low oxygen levels
  • Migraine headaches
  • Stroke
  • Transient ischemic attack (TIA), also known as a mini-stroke

Your UF Health cardiologist can help you determine if these symptoms are related to a PFO.

Diagnosing Patent Foramen Ovale

If your UF Health Jacksonville heart specialist suspects you may have a PFO that requires treatment, an echocardiogram (echo) to obtain detailed pictures of the heart will be recommended. Your doctor may also order what’s known as a “bubble test,” in which a saltwater solution is injected into the heart during the echo so your doctor can see whether the bubbles pass between the two chambers of the heart.

Treating Patent Foramen Ovale

If PFO is not causing any problems or symptoms, treatment is not required. In patients with PFO who have had blood clots or strokes, closure of the hole is recommended to reduce the risk of future strokes.

PFO closure is a minimally-invasive catheter-based procedure that does not typically require general anesthesia. The procedure is performed via the femoral vein in the groin thought a small puncture incision on the skin. The catheter system, a thin flexible tube, is inserted in the groin, advanced into the heart and placed in the left upper chamber through the PFO hole. A two-disc device is inserted through the catheter and used to close hole in the heart by placing one disc on each side of the hole. After the device is implanted, the catheter is removed and then the small incision in the groin will be stitched.

Medications to prevent clot formation (blood thinners) may be an alternative for the treatment of PFO.

Video: Cardioform ASD Occluder

Symptoms of Atrial Septal Defect

In many people born with ASD, the defect may close on its own and or is too small and do not cause symptoms that require treatment. However, symptoms may occur at almost any age, and can include:

  • Difficulty exercising or other physical activity
  • Frequent lung infections
  • Heart murmur
  • Heart palpitations
  • Shortness of breath
  • Stroke
  • Swelling in the legs, feet or abdomen

Diagnosing Atrial Septal Defect

If your heart specialist at UF Health Jacksonville suspects you may have ASD, one or more of the following tests may be ordered to aid in diagnosis:

  • Cardiac catheterization to assess congenital heart defects, measure the pressures inside your heart and check the heart arteries.
  • Chest X-ray to check your heart and lungs to help rule out other conditions that could be causing your symptoms.
  • Computed tomography (CT) scan to capture and analyze detailed images of your heart using X-ray.
  • Echocardiogram to obtain detailed images of your heart to check the valves and to look for heart defects.
  • Electrocardiogram to check the electrical activity of your heart for potential rhythm problems related with the ASD.
  • Magnetic resonance imaging (MRI) to capture and analyze 3D images of your heart to check for structural or function problems.

Treating Atrial Septal Defect

In many cases, an ASD will close on its own during childhood. Other times, the defect may be so small that it doesn’t cause any symptoms or consequences, and therefore no treatment is required. However, if symptoms develop or there is evidence of reduced heart function or heart chamber enlargement, closure of the ASD is required. Most people with the most common type of ASD (ostium secundum) are treated with catheter-based closure, while surgery is only recommended for very large ASDs or other uncommon ASD types.

  • Percutaneous ASD closure is a minimally-invasive catheter-based procedure that may not require general anesthesia. The procedure is performed via the femoral vein in the groin thought a small puncture incision on the skin. The catheter system, a thin flexible tube, is inserted in the groin, advanced into the heart and placed in the left upper chamber through the ASD hole. A two-disc device is inserted through the catheter and used to close hole in the heart by placing one disc on each side of the hole. After the device is implanted, the catheter is removed and then the small incision in the groin will be stitched. The heart tissue will then grow around the device, which permanently seals the hole.
  • Open-heart surgery. You'll be put under general anesthesia for this procedure. Your surgeon will make an incision on your chest and use a patch to close the hole. Depending on the type of ASD you have, the surgeon may be able to close your hole using minimally invasive surgery with small incisions.

Why Choose UF Health Treatment of PFO/ASD

The internationally recognized heart team experts at the UF Health Cardiovascular Center are leaders in cardiac care, research and education. Our doctors have been leaders in percutaneous transcatheter interventions and minimally invasive heart and chest surgery for more than two decades. Our interventional cardiologists and cardiothoracic surgeons are professors and researchers in one of the nation's largest cardiovascular training programs at the University of Florida College of Medicine – Jacksonville.

Our cardiologists, as faculty of the University of Florida Division of Cardiology – Jacksonville, participate in numerous national and international clinical trials. Using the most sophisticated equipment available, the center offers state-of-the-art diagnostic, therapeutic and rehabilitative cardiac services. Many leading-edge interventional therapies and more treatment options are offered in Northeast Florida only at the UF Health Cardiovascular Center – Jacksonville which in many cases means better outcomes for cardiovascular patients.