When Do You Need That Hole In Your Heart Closed?

A PFO in the heart can increase stroke risk for some
illustration of heart with hole

You may not know it, but there’s about a 25% chance that you’re walking around with a hole in your heart.

Advertising Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Everyone is actually born with one — before birth, this opening connects the right and left atria of the heart and allows blood to flow through. That’s how the body spreads oxygen before the lungs are working.

But when a baby takes its first breath after birth, it creates pressure in the body, pushing the foramen ovale together. The hole seals up in the first weeks of life in at least two-thirds of children, says interventional cardiologist Grant Reed, MD.

When the hole doesn’t close properly, it’s known as patent foramen ovale (PFO).

For the majority of adults who have it, PFO does not cause problems. But there are a few specific reasons that someone might consider having the hole closed to prevent problems down the road.

A stroke with an unknown cause

Most people who have a PFO do not have any symptoms. It may cause worry, though, if someone has a stroke without any clear cause.

Advertising Policy

If a stroke can’t be attributed to a common cause (atrial fibrillation or carotid artery disease, for instance), that means it’s possible that the PFO allowed a blood clot to travel through to the brain.

“If there is no ‘communication’ between the two sides of the heart, the blood clot would have gone to the lungs,” Dr. Reed explains.

Most small blood clots that go to the lungs cause no symptoms. However, if they are large enough, they could cause a pulmonary embolism, which is more serious but can usually be treated with medications.

Patent foramen ovale closure

There are only a couple of very specific reasons to close a PFO, Dr. Reed says:

  1. You’ve had a stroke or a “mini” stroke, known as a transient ischemic attack (TIA). If you have, then closing the hole can reduce the risk of recurrent strokes.
  2. If the PFO is sizable, it may allow large amounts of blood to move back and forth between the left and right sides of your heart. This can create pressure and cause your heart to enlarge. Closing the PFO can protect your heart’s function.

Interventional cardiologists typically perform a catheter-based procedure to close PFOs, placing a small disc in the hole between the two sides of the heart. Over time, heart tissue grows over the disc, closing the hole.

Advertising Policy

After this procedure, a patient would likely spend a night in the hospital for observation, then go home the next day, Dr. Reed says.

PFO closure surgery is safe and effective, he says.

A recent small study from the American College of Cardiology compared the procedure with medication management of PFO. Researchers found that no patients who had a PFO closure had a stroke in the next two years. During that same period, 12.9% of the study participants who were taking aspirin and blood thinners had another stroke.

“If you have had a stroke without a clear cause and have PFO, it’s reasonable to consider closure,” Dr. Reed says. “And if you know you have a PFO, it’s worthwhile to see a cardiologist. But if you don’t have stroke symptoms and your heart function is good, you won’t need the procedure.”

Advertising Policy