An atrial septal defect (ASD) is a hole in the septum that allows blood to flow from one atrium to the other, usually from the left side to the right, causing an overload on the right side. While most small ASDs close on their own during childhood, larger defects are less likely to close on their own.

A patent foramen ovale (PFO) occurs when the foramen ovale does not seal after birth. The foramen ovale is a natural shunt (channel) that allows blood to enter the left atrium from the right atrium. In most people, the foramen ovale closes within a year of birth. In about 25 percent of people, the hole stays partially open, leaving a tiny passage between the atria (PFO). Many people learn they have a PFO following an ischemic stroke (a stroke caused by a blocked artery). Closing a PFO may reduce the risk of recurrent stroke. Patients with migraine more frequently have a PFO, and the relationship between these two states is under investigation.

People who have these structural heart defects are at increased risk for arrhythmias, stroke and heart failure. Although people are born with these defects, in many cases they are unaware they have an ASD or PFO. Some may learn they have a defect when they experience problems as adults.

Echocardiography and transesophageal echocardiography (TEE) are used to diagnose ASD and PFO defects.

ASD and PFO Treatment

Our physicians are skilled in evaluating and repairing these defects. In fact, we were the first in Milwaukee to perform ASD and PFO closure without open surgery. If your condition requires repair, there are two possible approaches.

Minimally Invasive Surgery

In most cases, we are able to repair PFOs and ASDs using minimally invasive techniques that only require small incisions, eliminating the need to open the entire chest. In an operating room, the wall (septum) between the two upper chambers of the heart (atria) is closed with sutures or covered with a patch. 

Minimally Invasive Catheter Procedure

In the Cardiac Catheterization Laboratory, a catheter (a long, thin tube) is inserted into a large vein and advanced into the heart using imaging to guide the catheter's movement. A special closure device is placed on a cable, inserted through the catheter and moved to the site of the hole in the heart. Once in position, the closure device is released to cover the hole and remains in the heart to stop the abnormal flow of blood between the two chambers of the heart. The catheter is removed and, over time, the tissue of the heart grows over the device.

Compared to open surgery, the catheter procedure results in fewer complications, less time in the hospital, less pain and a quicker return to activities. Patients may be offered both types of treatment options. A PFO can almost always be closed using a catheter and a closing device. Some ASDs, however, cannot be closed via a catheter and require open surgery.

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