Diagnosis

Usually a PFO is diagnosed when tests are done for another health concern. If your primary care doctor thinks you may have a PFO or if you've already been diagnosed with one, a doctor trained in heart conditions (cardiologist) may recommend some type of echocardiogram to get a closer look at how your heart works.

If you're diagnosed with a patent foramen ovale and you have had a stroke, your doctor may also refer you to a doctor trained in brain and nervous system conditions (neurologist).

Tests

An echocardiogram is used to diagnose a PFO. An echocardiogram shows the anatomy, structure and function of your heart.

Transthoracic echocardiogram

In this common test, sound waves directed at your heart from a wandlike device (transducer) produce video images of your heart in motion. Doctors may use this test to diagnose a patent foramen ovale and detect other heart problems.

Variations of this procedure may be used to identify patent foramen ovale, including:

• Color flow Doppler. When sound waves bounce off blood cells moving through your heart, they change pitch. These changes (Doppler signals) are displayed in different colors on the echocardiogram and can help your doctor examine the speed and direction of blood flow in your heart.

  If you have a patent foramen ovale, a color flow Doppler echocardiogram could detect the flow of blood between the right atrium and left atrium.

• Saline contrast study (bubble study). During a bubble study, a sterile salt solution is shaken until tiny bubbles form and then is injected into a vein. The bubbles travel to the right side of your heart and appear on the echocardiogram.

  If there's no hole between the left atrium and right atrium, the bubbles will simply be filtered out in the lungs. If you have a patent foramen ovale, some bubbles will appear on the left side of the heart.

Transesophageal echocardiogram

A patent foramen ovale may be difficult to confirm by transthoracic echocardiography. Your doctor may need to do a special type of echocardiogram called a transesophageal echocardiogram to get a closer look at the heart and blood flow through the heart.

Unlike a standard echocardiogram, in which the wand (transducer) is moved across your chest, a transesophageal echocardiogram uses a small transducer attached to the end of a probe. A doctor gently inserts the probe down the tube leading from your mouth to your stomach (esophagus). Before the procedure starts, your throat will be numbed, and you'll be given medication (sedative) to keep you comfortable.

A transesophageal echocardiogram is generally the most accurate available test to diagnose a patent foramen ovale.