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Tests and diagnosis
By Mayo Clinic staffA heart specialist (cardiologist) can detect a patent foramen ovale with one of the following tests:
Echocardiogram
An echocardiogram shows the structure and function of your heart. The standard form of this test is called a transthoracic echocardiogram.
With this test, a technician spreads gel on your chest and then presses a device called a transducer against the skin over the heart. The transducer emits high-pitched sound waves and records the sound wave echoes as they reflect off internal structures in the heart. A computer converts the echoes into moving images on a monitor. Variations of this procedure may be used to identify patent foramen ovale:
- Color-flow Doppler. When sound waves bounce off blood cells moving through your heart, they change pitch. These characteristic changes (Doppler signals) and computerized colorization of these signals can help your doctor examine the speed and direction of blood flow in your heart. If you have a patent foramen ovale, a color-flow Doppler echocardiogram could detect the flow of blood between the right atrium and left atrium.
- Saline contrast study (bubble study). With this approach a sterile salt solution is shaken until tiny bubbles form and then is injected into a vein. The bubbles travel to the right side of your heart and appear on the echocardiogram. If there's no hole between the left atrium and right atrium, the bubbles will simply be filtered out in the lungs. If you have a patent foramen ovale, some bubbles will appear on the left side of the heart.
Transesophageal echocardiogram
This test uses a small transducer on a tube inserted down the esophagus, the part of the digestive tract that runs from the throat to the stomach. Because the esophagus lies close to the heart, having the transducer placed there provides a detailed image of the heart and blood flow through the heart. The use of a transesophageal echocardiogram makes it easier to see a patent foramen ovale by either color-flow Doppler or a saline contrast study.
- Atrial septal defect (ASD). American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=11065. Accessed April 22, 2010.
- Bashore TM, et al. Heart disease. In: McPhee SJ, et al. Current Medical Diagnosis and Treatment 2010. 49th ed. New York, N.Y.: McGraw-Hill; 2010. http://www.accessmedicine.com/content.aspx?aID=3671. Accessed April 22, 2010.
- Slottow TL, et al. Overview of the 2007 Food and Drug Administration Circulatory System Devices Panel meeting on patent foramen ovale closure devices. Circulation 2007;116:677.
- O'Gara PT, et al. Percutaneous device closure of patent foramen ovale for secondary stroke prevention: A call for completion of randomized clinical trials — A science advisory from the American Heart Association/American Stroke Association and the American College of Cardiology Foundation. Circulation. 2009;119:2743.
- Johansson MC, et al. The significance of patent foramen ovale: A current review of associated conditions and treatment. International Journal of Cardiology. 2009;134:17.
- Specific cardiac defects. In: Libby P, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50064-9--cesec197&displayedEid=4-u1.0-B978-1-4160-4106-1..50064-9--cesec222&uniq=197042004&isbn=978-1-4160-4106-1&sid=987452515. Accessed April 22, 2010.
- Sommer RJ. Patent foramen ovale: Where are we in 2009? American Journal of Therapeutics. 2009;16:562.
- Rothrock JF. Patent foramen ovale (PFO) and migraine. Headache. 2008;48:1153.
- Meier B. Catheter-based closure of the patent foramen ovale. Circulation. 2009;120:1837.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. May 3, 2010
- Rosenow E (expert opinion). Mayo Clinic, Rochester, Minn. May 3, 2010.
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