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Treatments and drugs
By Mayo Clinic staffMost people with patent foramen ovale don't need treatment. Though treatment is sometimes suggested, studies of patent foramen ovale treatments have produced inconclusive evidence.
Medications
Medications can be used to try to reduce the risk of blood clots crossing a patent foramen ovale. The benefit of aspirin and other blood thinners, such as warfarin (Coumadin), in treating patent foramen ovale isn't clear.
Most current studies suggest that warfarin isn't better than aspirin in reducing the chance of another stroke for people who've already had one. However, there may be another condition, such as irregular and chaotic heartbeats in the heart's upper chambers (atrial fibrillation), that indicates the need for warfarin.
Surgical and other procedures
Procedures to close patent foramen ovale include:
- Surgical repair. A surgeon can close the patent foramen ovale by opening up the heart and stitching shut the flap-like opening. This can sometimes be done with the use of "robotic" techniques and a very small incision.
- Device closure. Using cardiac catheterization, doctors can insert a device that plugs the patent foramen ovale. In this procedure, the device is on the end of a long flexible tube (catheter). The doctor inserts the device-tipped catheter into a vein in the groin and guides the device into place with the imaging assistance of an echocardiogram.
Reasons for closure
If patent foramen ovale is found when an echocardiogram is done for other reasons, a procedure to close the opening usually isn't performed. Procedures to close the opening in the heart may be used in the following circumstances:
- If your child is undergoing surgery to correct a congenital heart defect and your child also has patent foramen ovale, the surgeon may close the opening when making other repairs to the heart.
- In adults having other types of heart surgery, a patent foramen ovale may be closed at the time of the operation.
- Closure of a patent foramen ovale may be done to treat low blood oxygen levels resulting from right-to-left blood flow across the patent foramen ovale.
- Although there's disagreement about whether treatment is needed, closure of the opening has been used to treat migraine and to prevent recurring stroke, particularly when no cause of a first stroke can be identified.
Recommendations of professional organizations
Professional organizations have made the following recommendations about patent foramen ovale closure to prevent stroke or treat migraine:
- American Heart Association/American Stroke Association (AHA/ASA). The AHA/ASA professional guidelines say there's insufficient evidence to support closure in people who have had one stroke. If medications to prevent a second stroke aren't successful, then the procedure may be considered.
- American Academy of Neurology (AAN). AAN professional guidelines say there's not enough evidence to support closing patent foramen ovale for preventing stroke.
- American Headache Society (AHS). The AHS doesn't recommend surgical closure of patent foramen ovale to treat migraines.
Clinical trials
Some professional organizations have encouraged doctors to talk to those with patent foramen ovale about participating in clinical trials addressing the many unanswered questions about patent foramen ovale, stroke and migraine. Your doctor may suggest this option to you and provide information about trials in your area.
