Atrial Septal Defect and Patent Foramen Ovale

An atrial septal defect and a patent foramen ovale (PFO) are 2 types of holes in the wall (septum) of the heart. The septum is the wall that separates the two upper chambers (parts) of the heart. These chambers are called the right atrium and left atrium.

An atrial septal defect happens when the septum wall doesn’t grow completely before a baby is born. The larger the hole, the more likely it is to become a problem.

A foramen ovale is hole that’s supposed to be there before a baby is born and then close after birth. In as many as 1 out of every 4 people, the hole doesn’t close and becomes a patent (open) foramen ovale. As many as 1 out of every 4 people have a PFO.

A PFO hole is usually smaller than a hole from an atrial septal defect. The larger the hole, the more likely it is to cause the following problems:

• The body not getting enough oxygen. Normally, blood in the right side of the heart doesn’t have much oxygen. The heart pumps the blood from the right side of the heart to the lungs to get oxygen. Oxygen-rich blood comes back to the heart on the left side, where it is pumped out to the rest of the body. A hole in the septum lets oxygen-filled blood (from the left atrium) leak back into the right side of the heart instead of getting pumped out to the body. In effect, the oxygen in that blood is wasted. The heart and lungs have to work harder to get oxygen to the body.
• Blood clots that can travel to the heart and brain, potentially causing a stroke.

Some people with an atrial septal defect never have symptoms. It depends on how big the hole is and where it is. Sometimes a person with a small hole won’t have symptoms until middle age or later.

Patent foramen ovale is common, but most people never have symptoms.

When symptoms of either type are present, they may include:

• Trouble breathing or getting enough breath, especially during exercise or activity
• Getting tired quickly during exercise or activity
• A lot of respiratory infections (colds and coughs) in children
• Heart palpitations (hard, fast, or irregular heartbeats)
• Migraine headaches (more common with patent foramen ovale)
• Fainting
• High blood pressure in adults who have not been treated

In serious cases, these symptoms may happen:

• Stroke or transient ischemic attack (TIA or a “mini-stroke”)
• Heart failure

Call 911 immediately if a person is having signs of a stroke or heart attack.

The abbreviation BE FAST can help you remember the signs of stroke:

• Balance: sudden loss of balance or coordination
• Eyes: sudden change in vision
• Face: sudden weakness of the face
• Arms: sudden weakness of an arm or leg
• Speech: sudden difficulty speaking
• Time: time the symptoms started

Signs of a heart attack include:

• Lightheaded feeling, dizziness, nausea, or cold sweats
• Pressure, fullness, or squeezing in the chest that lasts more than a few minutes or keeps coming back
• Pain or discomfort in other parts of the upper body, like the neck, shoulders, or arms

Make an appointment to see the doctor if you have any of these symptoms:

• Frequent severe migraines
• Fainting spells
• Tendency to get tired quickly during activity
• Heart palpitations — hard, fast, or irregular heartbeats

The cause of both atrial septal defect and patent foramen ovale is unknown.

Tests to diagnose atrial septal defect or patent foramen ovale (PFO) are usually done only if a person has symptoms. If the hole from an atrial septal defect is large enough, the doctor will sometimes be able to hear a heart murmur when listening to your heart during a routine exam.

To diagnose a PFO, the doctor will use an echocardiogram (Echo). This test uses ultrasound to make a picture of the heart. Sometimes the foramen ovale is still hard to see, so the doctor will do a "bubble test." The doctor will inject salt water into the body and watch to see if there are little air bubbles moving from the left to the right of the heart. This means there is likely a hole. 

These tests can help the doctor diagnose an atrial septal defect:

• Echo. Uses ultrasound to make a picture of the heart.
• Doppler echo. Uses sound waves to look at how the blood is flowing in the heart.
• Coronary angiography. Uses x-ray and a special dye to show how the blood is flowing in the heart.
• Electrocardiogram (ECG or EKG). Checks the rhythm of the heart by looking at its electrical activity.
• Magnetic Resonance Imaging (MRI) of the heart, which generates a detailed image of the heart structure.

Patent foramen ovales (PFO) typically don’t cause problems and don’t need to be treated. If a PFO is causing symptoms, treatment could include:

• Medicine. The first type of treatment the doctor will try is blood-thinning medicine (such as aspirin or warfarin) to prevent blood clots from forming. This does not close the hole but does prevent the problems.
• Surgery. In some cases, a procedure may be recommended to close the hole with a device. This device is put in place with a catheter (a thin, flexible tube) that is moved through a vein from the groin to the heart. Some people may need open-heart surgery to close the hole, but this is rare.

Small atrial septal defects that are not causing problems don’t need to be treated. However, if the hole is large and a lot of blood is leaking, surgery may be needed to close the hole. The hole can be closed with a closure device that the doctor puts in with a catheter (tube) that goes from the groin through a vein to the heart.

Sometimes open-heart surgery is needed to close the hole. This is especially true when the person has other heart problems in addition to the hole.

There is no known way to prevent a patent foramen ovale or atrial septal defect. But you can prevent serious problems like stroke and heart failure by paying attention to your symptoms and treating them early.

American Heart Association "Patent Foramen Ovale"

Medline Plus "Patent Foramen Ovale"

Medline Plus "Atrial Septal Defect"

An atrial septal defect and a patent foramen ovale are 2 types of holes in the wall (septum) that separates the 2 upper chambers (parts) of the heart.

An atrial septal defect happens when the septum wall doesn’t grow completely before a baby is born. The larger the hole, the more likely it is to become a problem.

A foramen ovale is hole that’s supposed to be there before a baby is born and then close after birth. In as many as 1 out of every 4 people, the hole doesn’t close and becomes a patent (open) foramen ovale.