Harvard Heart Letter

Heart Beat: Hole in the heart

Heart Beat

Hole in the heart

All babies are born with a hole in the heart between the right atrium and the left. Although it usually closes within a year or so, in up to one-third of people a small opening remains into adulthood. This hole, called a patent foramen ovale, usually has no effect on heart function. It has been branded, though, as a cause of stroke in some young adults. Now there is new evidence that it could be responsible for some strokes in older people, too.

Writing in the Nov. 29, 2007, New England Journal of Medicine, German researchers showed that a patent foramen ovale was far more common in older people who had strokes of "unknown origin" than in those whose strokes could be traced to atrial fibrillation or other causes. A patent foramen ovale plus a ballooning of the wall between the right and left atria, called an atrial septal aneurysm, was even more problematic.

Doctors can close a patent foramen ovale with a small, umbrella-like plate that fits over the hole. It is put in place using a catheter inserted into a blood vessel in the groin which is carefully advanced into the heart. Closing a patent foramen ovale makes sense in younger people; whether it is worth the risks of the procedure in older folks is something researchers need to determine.

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