PFO/ASD Closure

Learn more about PFO, ASD and stroke research.
The heart is divided into four separate chambers. The upper chambers, or atria, are divided by a wall called the atrial septum.

The foramen ovale is a flap or tunnel shaped hole in the atrial septum during fetal development that allows blood to travel through the heart without going to the lungs. When in the womb, a baby does not use his or her own lungs, receiving oxygen rich blood from the mother through the umbilical cord. Therefore, blood can travel from the right side of the baby's heart to the left side of the heart through the foramen ovale, skipping the trip to the baby's ungs.

This small flap-like opening normally closes shortly after birth as the pressure from the baby's heart pushes the flap to the septal wall. If this opening does not close shortly after birth, a Patent Foramen Ovale (PFO) results. For people with PFO, some blood from the right atrium can leak into the left atrium. PFO is the most common heart defect. In fact, one in four people may have a PFO to some degree, but in many cases the PFO is not large enough to create symptoms or require any immediate treatment in childhood.

 
Patent Foramen Ovale is categorized as an atrial septal defect, but with a different origin and symptoms than single-hole or multi-fenestrated atrial septal defects.

Many people grow up and lead normal lives without even knowing that they have a PFO. PFO is frequently not diagnosed until adulthood. However, there are a number of life-affecting and potentially harmful conditions that may be caused by PFO.
Patent Foramen Ovale is suspected to be a cause of embolic cryptogenic stroke. This type of stroke has no clearly known origin, but blood clotting at or near the PFO is one possible cause. Research is underway to verify this connection between embolic cryptogenic stroke and PFO.

In recent years, research into PFO closure has shown that there may be a connection between PFO and migraine headaches. People with migraine headaches who have had PFO closure for other reasons often reported reduction or even cessation of migraine headaches after PFO closure. For this reason, research is underway to determine the effect of PFO closure in reducing or eliminating some forms of migraine.
Understanding Atrial Septal Defect (ASD)

Atrial Septal Defect
The heart is divided into four separate chambers. The upper chambers, or atria, are divided by a wall called the atrial septum.

An atrial septal defect (ASD) is a hole in that septum. Atrial septal defects are one of the most common heart defects, and are caused by incomplete growth of the septal wall during fetal development. When an atrial septal defect is present, blood flows through the hole, usually from the left atrium to the right atrium. This increases the blood volume in the right atrium, which causes more blood to be pumped to the lungs. This short circuit of blood flow is inefficient for providing circulation to the body.

In some infants and young children, an atrial septal defect may not result in any outward symptoms. A larger defect may allow so much blood flow through the hole that congestive heart failure symptoms such as shortness of breath, fatigue, and slow growth may be seen even in young children.

If a larger ASD is left untreated in children, atrial septal defect may cause problems such as failure to grow and develop normally, and an inability to gain weight. In adulthood, additional problems may include pulmonary hypertension (high blood pressure in the lungs), congestive heart failure (weakening of the heart muscle), atrial arrhythmias (abnormal rhythm or beating of the heart) and an increased stroke risk.

The ASD can be one hole, or a number of smaller holes. An ASD with a number of smaller holes is called a "multi-fenestrated atrial septal defect" and is sometimes described by physicians as looking like "Swiss Cheese" in the atrial septum wall.

Fenestrated Fontan
Fenestrated Fontan Palliation is a surgical procedure in which a "baffle" is constructed in the heart to help with blood circulation for hearts with multiple defects that can cause life-threatening heart dysfunction. During this procedure, the surgeon makes a small hole (fenestration) in the baffle to help relieve the symptoms of the heart disease. Fenestrated Fontan Palliation is often performed in infants and children, but may be performed in adults also to provide adequate circulation until additional procedures can be performed to establish more normal heart function.

The fenestration is a small hole created by the surgeon to permit a small amount of blood flow to go from the Fontan baffle directly to the left heart without going through the lungs. This is generally thought to be beneficial early after surgery. Once the patient has recovered from the operation, the cardiologist may feel the fenestration or small hole, is no longer needed, and the fenestration can be closed like an atrial septal defect.

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