Information for patients

Links

Wellington Hospital
Imperial College Healthcare NHS Trust
Clementine Churchill BMI (Harrow)
Lindo Wing, St Mary's Hospital

Patient testimonials

First, I can’t thank you enough for all your time, interest and care on Thursday.

Secondly, the one stop ‘plumb and sparks’ shop is seriously impressive, staffed by great, caring and efficient people who are fun. In about an hour to do an echo, treadmill test and take 49 blood samples etc. must be close to a W.R....

Seriously, from the patients point of view you are offering full diagnostics almost in the ‘golden hour’ whereas with most other approaches it takes more like a month! The expeditious approach apart from removing patients uncertainty which often weighs heavily means if necessary you are in to treatment almost immediately....

Patients will definitely feel that they and their quality of lfe is being put first.

Mr Y. (2010) Suffolk.

Patent Foramen Ovale (PFO)

In the womb, the lungs are full of fluid. Sending blood there would be a waste of effort for the baby, so they are bypassed by having blood flow across from the right side of the heart (right atrium) to the left side (left atrium) via a flap valve called the foramen ovale. With the first breath, the flap closes. In 75% of people it seals completely. In 25%, it can open in certain conditions, such as sniffing or coughing, when the pressure in the right side is higher than that on the left side of the heart. This is called a patent foramen ovale (PFO).

Transoesophageal echocardiogram (TOE) showing a dumbbell shaped clot coming across the patent foramen ovale (PFO) (arrowed white). Taken from GJ Koullias et al Circulation. 2004;109:3056-3057

In most people, a PFO is of no consequence. Therefore we do not screen healthy people for a PFO. There is evidence that it becomes more relevant in a few types of patients:

Divers who have had decompression illness- “the bends”. Brain scans suggest that even in divers who do not suffer decompression clinically, those with a PFO suffer more “asymptomatic” injury to the brain than those without. For this reason, the PFO is taken seriously after the first episode of decompresson and the PFO usually recommended for closure.
Patients <55 years old who have had stroke. Again, PFO is more common in this group than in the general population. Although very strong evidence is still lacking, circumstantial evidence suggests that the PFO may be relevant and again PFO closure is often recommended.
Migraine with aura - This is an area of active clinical research. There is not enough evidence to close the PFO if you have migraine headache with a preceeding aura, but if the headaches are severe and disabling, it would be worth considering all options with your neurologist or headache specialist.

How is it diagnosed?

Diagnosis is made using a bubble echocardiogram. In some cases a transcranial Doppler may be used instead for screening purposes. However, it is not as specific for a PFO as the bubble echocardiogram. A Transoesopageal echocardiogram (TOE) will often be needed to exclude other heart defects and confirm that the PFO is suitable for closure. (see PFO closure) Most closures are done with umbrella devices with keyhole procedures rather than open surgery.

Patent Foramen Ovale (PFO)

Transoesophageal echocardiogram (TOE) showing a dumbbell shaped clot coming across the patent foramen ovale (PFO) (arrowed white). Taken from GJ Koullias et al Circulation. 2004;109:3056-3057

How is it diagnosed?

Bubbles with and without straining- the lower picture shows bubbles going across a PFO