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Congenital Defect Closure

Congenital Defect Closure for Atrial Septal Defects and Patent Foramen Ovale

A patent foramen ovale, or PFO, is an opening between the upper two chambers of the heart that failed to close after birth. This and other congenital defects, such as atrial septal defects, are sometimes referred to as a “hole in the heart.” Atrial septal defects exists in about 25 percent of the population.

Most of the small defects go undetected and may not produce any significant symptoms. Under certain circumstances, however, symptoms may occur. In fact, PFO may be the most likely cause of stroke in patients under the age of 55. The condition predisposes a patient to stroke when small, often undetectable, clots forms in the pelvic region or lower extremities. If the clot breaks loose, and pressure on the right side of the heart increases during straining or activity, the clot can cross the patent foramen ovale and end up on the arterial side where it may go to the brain or other organs. The clot can also cause a heart attack.

Symptoms of Patent Foramen Ovale or Atrial Septal Defects

Most people with patent foramen ovale or small atrial septal defects have no symptoms or signs of a defect. Besides a stroke, blood traveling between the atrial chambers of the heart may cause symptoms such as fatigue, shortness of breath, or cardiac rhythm abnormalities. Patients with large holes may have a heart murmur, either previously undetected or never evaluated. Unfortunately, a patent foramen ovale or small atrial septal defect cannot be detected by physical exam. Echocardiography (ultrasound imaging) is the preferred imaging study to show cardiac defect.

Because of hereditary factors associated with atrial septal defects, close family members of someone with a confirmed defect should have an echocardiogram.

Advancing Treatment Options

Patent foramen ovale is increasingly being suspected as the cause of blood clotting and embolisms. Once a patient with patent foramen ovale has had a blood clot, they usually are treated with a blood thinner – Coumadin – to prevent a recurrence of clots. However, many younger people are poor candidates for Coumadin because they are in an active stage of life. For example, women of childbearing age, heavy laborers and athletes should not take Coumadin.

Dr. John Lasala, a cardiologist at the Heart & Vascular Center, is using a non-surgical intervention technique to close holes in patients who are not good candidates for Coumadin or who have had an event while on medication. Using what is called an Amplatzer or Helex septal occluder device, Dr. Lasala is able to repair patent foramen ovales and other congenital heart defects through a vein in the leg.

The Amplatzer device limits the recurrence rate of clots to approximately 1 percent or less. To be qualified for this procedure, patients must have had a stroke or embolism and have all other traditional sources of clot formation eliminated. Since the use of the closure device for patent foramen ovale closure is still relatively new, patients must qualify to be treated.

This technique has improved the quality and extended the life of many patients, making us a leader in this type of therapy for the Midwest region.

To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call 855.925.0631.