Patent Foramen Ovale (PFO)
This defect is present in every newborn baby. It is a gap in the wall between the upper two chambers of the heart, which should close soon after birth.
Whilst a baby is in the womb, oxygen is supplied by the placenta via the umbilical cord and the baby's lungs are not expanded and require only a small amount of blood for them to grow. The patent foramen ovale is one of a number of nature's "short circuits" which allows blood to bypass the baby's lungs whilst in the womb.
Usually the ductus arteriosus (a connection between the aorta and the lung artery) and the other "short circuits" close within a few days of birth, and the connections between the two sides of the heart no longer exist. The resistance to blood flow quickly falls with the onset of breathing and the left side pressures become greater than the right, this pushes the flap of the Patent Foramen Ovale closed and in most people it seals over.
Where there are no other defects the patient will not usually have any symptoms.
Where the PFO is the only defect it rarely needs treatment, unless as part of a heart operation for other problems or if there is a complication of the hole itself.
However, if there are reasons to close this hole, this can be performed surgically with a couple of stitches or with a closure device placed by cardiac catheterisation (See Cardiac Catheterisation Topic Note).
Follow Up Advice
If there is a small hole (patent foramen ovale), then children and adults can usually live their lives normally. However, it is advised that they should not undertake deep sea commercial diving, and should not become air line pilots.
If the hole closes, as it normally does, then there is no need for further follow up.
After device closure in the catheter laboratory, advice should be sought from your local cardiologist. Usually, aspirin is given for a few months, and antibiotic prophylaxis should be given before dental extraction or any other potentially septic operation for a while afterwards.