Patent Foramen Ovale (PFO) in Children

A patent foramen ovale (PFO) is a hole in the wall that that separates the heart’s two upper chambers (atria). All babies have this opening (called a foramen ovale) before birth to allow blood to bypass the lungs. Shortly after birth, the tissue usually grows together and closes the hole. But in about 25 percent of people, the hole remains open (patent), resulting in a PFO. Many people have a PFO and never know it.

A PFO is similar in location to atrial septal defect (ASD), but it is smaller and rarely causes problems on its own.

Some children with more serious heart defects also have a PFO. Unless a child has other heart defects, it is unlikely that he or she will ever have symptoms or problems from PFO.

Most children have no symptoms from a PFO unless they also have other heart defects.

In rare cases, a baby with a PFO will develop a bluish skin tone (cyanosis) when straining or crying.

Some studies have also associated PFOs with an increased risk for migraine headaches and cryptogenic stroke (a stroke with no known cause).

It is not know why this opening doesn’t close in some people, but it’s thought that heredity and genetics may play a role.

Most people with a PFO have no symptoms, so it’s most often found “incidentally” during an exam for another problem.

If your baby sometimes turns blue for short amounts of time, your doctor may order one or more of these tests:

• Electrocardiogram (ECG or EKG)
• Echocardiogram (cardiac ultrasound). As part of the echocardiogram, the doctor may also do a bubble study. For this study, an intravenous (IV) line that contains saline is put into your child’s arm, causing little bubbles in the bloodstream. If your child has a PFO, these bubbles work their way to the left side of the heart and show up on the echocardiogram.

Most PFOs don’t need any treatment. If your child needs surgery for another heart defect, the PFO may be closed at the time of the surgery.

In rare cases, your child’s doctor may recommend closing the PFO surgically. Some studies have shown that closing a PFO may relieve migraines or reduce the risk of stroke in those who have already had a stroke, but the evidence is not conclusive.

The procedure to close a PFO is a fairly simple. A catheter is used to guide a special closing device to the area of the PFO. The device expands, forming a patch that covers the hole.

After the procedure, most children go home the same day or the next day.

The doctor may prescribe aspirin for your child to take for a few months after the procedure as a precautionary measure.

It’s unlikely that your child will need treatment for an isolated PFO. But if your child does need care, our team in the Boston Children’s Hospital Benderson Family Heart Center treats some of the most complex pediatric heart conditions in the world.

Our clinicians will work closely with you to determine the right treatment plan for your child. We provide families with a wealth of information, resources, programs, and support — before, during, and after your child’s treatment.