Patent Foramen Ovale
(PFO)
Treatment
If you’re diagnosed with a PFO, your doctor will explain several treatment options, including lifestyle changes, anticoagulant therapy, and PFO closure by either surgical repair or device closure. There’s been much debate about whether PFOs should be treated with blood-thinning medications or closed with devices. There’s also been some suggestion that migraine headaches may be related to PFOs and that closing PFOs may improve these symptoms. If any of these issues apply to you and you’ve been diagnosed with a PFO, work with your doctor to determine the best treatment option for you. Be sure to speak to your doctor about SCAI’s Guidelines for the Management of Patent Foramen Ovale and what they suggest may be best for you.
Lifestyle changes
When you’re diagnosed with a patent foramen ovale (PFO), it’s important to make certain heart-healthy lifestyle modifications to help reduce your chances of having a stroke, which is linked to people who have a PFO.
- Adopt a heart-healthy diet – Strive to eat a balanced diet with plenty of fruits, vegetables, grains, and a moderate amount of protein (meat, fish, eggs, milk, nuts, tofu, and some beans). Eating foods with lots of fiber, such as whole-grain bread and cereals, raw fruits and vegetables, and dried beans, and reducing salt and fat has been found to reduce cholesterol and blood pressure, thus helping lower your risk of stroke.
- Stop smoking – Smoking doubles your risk of having a stroke. You can dramatically lower your risk of stroke by quitting today.
- Keep your blood pressure under control – High blood pressure can damage the blood vessels and increase your risk of stroke. Discuss your concerns with your doctor, as you may need medication to help lower and maintain your blood pressure.
- Exercise regularly – A brisk walk for just 30 minutes each day is good for your health and may reduce the likelihood of a stroke. If walking is not an option, choose another activity you enjoy. The important thing is to make time each day for exercise.
- Find out if you have atrial fibrillation (Afib) – AFib is an irregular heartbeat that contributes to blood pooling (and clumping or clotting) in the upper chamber of your heart. Clots pushed out of the heart by its beating can lodge in vessels and block blood flow to the brain, causing a stroke. If you have AFib, your care team may prescribe medications that thin the blood and prevent it from clotting as easily, or your doctor may recommend a procedure that prevents blood clots from forming in your heart and traveling to your brain, where they could cause a stroke.
- Limit alcohol intake – Too much alcohol can significantly increase your stroke risk. If you must drink alcohol, limit your intake to no more than one drink (12 ounces of regular beer, 5 fluid ounces of wine, or 1.5 fluid ounces of liquor) per day for women* and two drinks per day for men*.1
- Lower your cholesterol – Cholesterol is a soft, waxy fat in the bloodstream and the body’s cells. A total cholesterol level of more than 200, a high “LDL” (“bad” cholesterol) level, or a low HDL (“good” cholesterol) level may indicate an increased risk for stroke. If your cholesterol is high, your doctor may recommend making lifestyle changes, including eating a heart-healthy diet and getting regular physical activity to bring it down. You may also prescribe medications to lower your cholesterol and reduce your risk for stroke.
- Control your diabetes – By controlling your diabetes, you may reduce your risk of stroke. Successfully managing diabetes requires following your doctor’s advice on eating habits, exercise, and diabetes medications.
- Find out if you have blood or blood circulation problems – Ask your doctor if you have blood or blood circulation problems that could increase your risk for stroke. If you have clotting disorders such as hemophilia, sickle cell disease, severe anemia in which your red cell count is lower than normal, or other blood conditions, talk to your doctor about medication and other ways of treating them to reduce your risk of stroke.
- Follow up with your doctor on testing and treatment – Your doctor can check blood flow through your heart and arteries using a variety of tests. Depending on the results, your doctor may prescribe medications or recommend medical procedures to improve blood flow and reduce your risk of stroke.
Anticoagulant therapy
Because a stroke is often caused by a blood clot that passes to the brain, lowering or eliminating the risk of blood clot formation is essential. One way this is accomplished is by using medications known as anticoagulants, which are blood thinners.
While these medications are effective, they can cause bruising, or bleeding may take longer to stop. For most people, the bleeding risk associated with taking blood thinners is less serious than having a stroke. However, the risks versus benefits of blood thinners vary from one patient to another, so you should discuss them with your doctor. Also, being on blood thinners may require strict adherence to testing and, at times, certain dietary and lifestyle modifications.
The most commonly prescribed anticoagulants include the following:
- Warfarin (Coumadin)
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)
Watch this video to learn more about PFO closure.
PFO closure
Another method of reducing the risk of stroke is to close the PFO so that blood can no longer move across the heart through PFO. If the PFO is closed, a clot forming on the venous side can’t cross through the PFO.
The PFO can be closed off in the following ways:
- Device closure – A less invasive option for closing the PFO is using a small occluder device inserted into the heart through a vein, known as a transcatheter closure of the PFO. It’s a procedure that was first used successfully in 1989 and has become the treatment method of choice since that time.
- Surgical repair – While surgical repair of a PFO is feasible and effective, it’s rarely done as a stand-alone procedure because it’s an invasive surgery—generally known as open heart surgery. Surgical repair of a PFO is often performed while the patient is already undergoing open heart surgery for another reason (e.g., valve replacement surgery). However, a doctor rarely orders open heart surgery to close a PFO.
*The term “women” in the context of “women’s cardiovascular health” applies to individuals assigned female at birth (AFAB) who have a female biological reproductive system, which includes a vagina, uterus, ovaries, Fallopian tubes, accessory glands, and external genital organs.
*The term “men” in the context of “cardiovascular health” applies to individuals assigned male at birth (AMAB) who have a male biological reproductive system, which includes a penis, scrotum, testes, epididymis, vas deferens, prostate, and seminal vesicles.