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‫بسم هللا الرحمن الرحيم‬
‫بسم هللا الرمحن الرحيم‬
Presented by Dr. MOHAMMAD ISMET
M.B.Ch.B.-C.A.B.M.S.-F.I.B.M.S.
Practicing pediatric cardiology
What is a PFO?
A patent foramen ovale
(PFO) is a defect in the
septum (wall) between the
two upper (atrial) chambers
of the heart. Specifically, the
defect is an incomplete
closure of the atrial septum
that results in the creation
of a flap or a valve-like
opening in the atrial septal
wall . A PFO is present in
everyone before birth but
seals shut in about 80% of
people.
When blood moves directly from the right atrium to
the left atrium, this blood bypasses the filtering system
of the lungs (the lungs actually do dissolve tiny blood
clots). If debris is present in the blood, such as small
blood clots, it now passes through the left atrium and
can lodge in the brain, causing a stroke, or another
organ, such as the heart, eyes, or kidneys.
With each heart beat or when a person with this
defect creates pressure inside his or her chest - such as
when coughing, sneezing, or straining during a bowel
movement - the flap can open, and blood can flow in
either direction directly between the right and left
atrium.
Symptoms
other heart Infants with a patent foramen ovale and no
defects do not have symptoms. Although present in
about one in five adults, PFOs usually cause no
symptoms at all. Far less than 1% has a stroke or other
outcome that results in the need to have the PFO
closed.
What causes a PFO?
The cause of a PFO is unknown. There are no known
factors. A PFO is congenital, meaning it is a defect risk
that is inborn or exists at birth. Stated another way, the
defect is an abnormality, not a disease. The septum
between the two atria of the heart developed normally
before birth, but the flap did not seal completely after
birth.
How is a PFO diagnosed?
Frequently a PFO is not diagnosed until a child or adult
with this defect has a transient ischemic attack (TIA) symptoms of a stroke that last for less than 24 hours - or
a stroke. Symptoms of a TIA or stroke include any of the
following:
*Sudden numbness or weakness in the face, arm or leg
(especially on one side of the body)
*Difficulty speaking or understanding words or simple
sentences
*Sudden blurred vision or decreased vision in one or both
eyes
*Difficulty swallowing
*Dizziness, loss of balance or coordination
*Brief loss of consciousness
*Sudden inability to move part of the body (paralysis)
Signs and tests
An echocardiogram can be done to diagnose a PFO. If
the PFO is not easily seen, a cardiologist can perform a
"bubble test." Saline solution (salt water) is injected
into the body as the cardiologist watches the heart on
an ultrasound (echocardiogram) monitor. If a PFO
exists, tiny air bubbles will be seen moving from the
right to left side of the heart.
Treatment
This condition is not treated unless other heart abnormalities exist or if you had a
stroke caused by a blood clot to the brain.
Treatment usually requires cardiac cathertization by a specifically trained cardiologist
to permanently seal the PFO.
How is a PFO closed using a
catheter-based procedure?
The catheter is initially inserted
into a large vein through a small
incision made usually in the inner
thigh (groin area) and then is
advanced into the heart. One or
more tests will be done to measure
the PFO and to be sure there are
no other defects.
An imaging test called angiography, (an injection of a certain
type of dye followed by an x-ray motion picture) may be used
to better visualize the heart.
An ultrasound imaging technique, to see the defect better
and also to determine the size of the closure device needed,
may be used. Intracardiac echo (ICE), involves passing an
imaging device up to the heart through the vein in the
patient’s other leg. Another technique uses an ultrasound
probe passed down the esophagus (transesophageal echo, or
TEE) to allow to see the heart structures and blood flow as the
device is being placed. In addition, a special balloon on a
catheter is moved to the area of the hole and inflated across
the hole in order to measure the size of the hole when it is
gently stretched.
A PFO closure device is moved
through the catheter to the heart
and specifically to the location of
the heart wall defect. Once in the
correct location, the PFO closure
device is allowed to expand its
shape to straddle each side of the
hole. The device will remain in
the heart permanently to stop the
abnormal flow of blood between
the two atria chambers of the
heart. The catheter is then
removed and the procedure is
complete.
How does the body react to a permanent implant?
The materials used in the closure device products have a proven
long-term safety history and have been widely used in heart
surgery procedures. It’s not likely that the body will have a
negative reaction to these devices. Within a few days, the body’s
own tissue will begin to grow over the device. By 3 to 6 months,
the device is completely covered by heart tissue and at that
point becomes a part of the wall of the patient’s heart.
The patient will not be able to feel the device. The implant will
not be affected by airport or other security sensors, or by any
household appliances, or medical imaging methods. However,
the clarity of medical images may be slightly reduced because of
the wire frame on the occluder devices. For this reason, be sure
to inform the imaging technician that you or your child has
such a device in your heart. You will receive an identification
card that should be carried with you/or by your child to show to
medical personnel if necessary.