Patent Foramen Ovale

Overview

A Patent Foramen Ovale (PFO) is a small flap-like opening between the upper chambers of the heart (the right and left atria) that fails to close naturally after birth. In most people, this opening causes no symptoms or health problems. However, in some cases, it may allow blood clots or air bubbles to bypass the lungs and travel directly to the brain — potentially causing a stroke, particularly in younger adults.

At The Royal Buckinghamshire Hospital, we support adults who have experienced a stroke related to a PFO with structured inpatient neurorehabilitation. Our goal is to restore mobility, communication, and independence through personalised, consultant-led care.

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What Is a Patent Foramen Ovale?

Before birth, the foramen ovale allows blood to bypass the lungs (which are not yet in use). Normally, this hole closes shortly after birth. However, in about 25% of the population, it remains open — this is known as a patent foramen ovale.

A PFO by itself does not typically cause problems. But in rare cases, a small clot or air bubble from the veins may pass through the opening and reach the brain, where it can cause a cryptogenic stroke (a stroke without an obvious cause).

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Symptoms of PFO

Most people with a PFO are asymptomatic and unaware they have it. However, it may be discovered during investigation for:

• Cryptogenic stroke, especially in younger adults
• Transient ischaemic attack (TIA)
• Unexplained migraine with aura
• Low blood oxygen levels (very rare)

If a stroke occurs due to a PFO, symptoms are the same as other types of stroke:

• Facial droop or asymmetry
• Arm or leg weakness (usually one side)
• Slurred or lost speech
• Vision problems
• Sudden confusion, dizziness or collapse

Diagnosis is usually confirmed with bubble contrast echocardiography, transoesophageal echo (TOE), or other advanced cardiac imaging.

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Link Between PFO and Stroke

A PFO may allow blood clots, which would normally be filtered out by the lungs, to bypass this system and travel directly to the brain. This is known as a paradoxical embolism.

PFO is more commonly linked to ischaemic strokes in patients under 60, particularly when no other risk factors are found. In these cases, PFO closure may be recommended after careful cardiology review.

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Rehabilitation After PFO-Related Stroke

Patients referred to us typically arrive after their stroke has been diagnosed and medically treated, including any investigations or cardiology input. Our role is to provide post-stroke neurorehabilitation to improve function and quality of life.

Our Inpatient Programme Includes:

Physiotherapy

• Strength, balance and gait retraining
• Coordination and postural work
• Fatigue and endurance management

Occupational Therapy

• Upper limb recovery and fine motor skills
• Self-care retraining (washing, dressing, eating)
• Sensory re-education and home environment planning

Speech & Language Therapy

• Communication recovery (aphasia, slurred speech)
• Swallowing assessments and safe feeding plans
• Support with reading, writing and comprehension

Neuropsychology

• Emotional wellbeing and adjustment support
• Cognitive rehabilitation
• Memory and attention strategies

Specialist Nursing

• Medication and blood pressure monitoring
• Skin care and continence management
• Nutrition, hydration and psychological support

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Who We Can Help

We accept adults (18+) who:

• Have had a stroke or TIA linked to a PFO
• Are medically stable and ready to begin rehabilitation
• Require inpatient therapy to regain independence
• May also have cardiovascular risk factors (e.g. hypertension, hyperlipidaemia)
• Are awaiting or recovering from PFO closure (procedure not carried out at Royal Bucks)

Call 01296 678800 or enquire online for admission guidance.

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Why Choose The Royal Buckinghamshire Hospital?

• Specialist in post-stroke rehabilitation, including cryptogenic stroke
• Consultant-led multidisciplinary approach
• Comfortable private setting with therapy up to 7 days a week
• High staff-to-patient ratio with 24/7 nursing
• Focused on restoring confidence, communication and quality of life