What is patent foramen ovale closure?
Before birth every baby has a small flap-like opening between the two upper chambers of the heart, called the foramen ovale. In most people it seals soon after birth, but in about one in four adults it stays partly open; this is a patent foramen ovale, or PFO. Usually it causes no trouble at all. Occasionally a small clot from the veins slips through the opening into the left side of the heart instead of being filtered by the lungs, and travels to the brain causing a stroke. Closure is a procedure in which a small double-disc device is placed across the opening through a catheter, sealing it permanently as the body grows its own lining over the device.
Why is it done?
Closure is considered mainly for younger and middle-aged patients who have had a stroke for which no other cause can be found, where the PFO is the most likely explanation. Studies have shown that closing the opening in carefully selected patients reduces the chance of another stroke more than medication alone. Closure is not recommended simply because a PFO has been found by chance and it is not a well proven treatment for migraine.
What happens on the day?
In the catheterisation laboratory a drip is placed, the groin is numbed with local anaesthetic and you are given a general anaesthetic. A catheter is passed from a vein in the groin to the heart, the opening is crossed with a soft wire and the closure device is advanced in a collapsed state and opened so that one disc sits on each side of the wall between the upper chambers of your heart. X-ray and ultrasound confirm that the device is well seated and that the hole is closed before it is released.
What to expect afterwards
You lie flat for a few hours so the groin seals and are usually home the next morning. You will take antiplatelet medication, usually aspirin with or without a second agent, for several months while the device becomes covered by the body lining.
Possible complications
Closure is generally low risk, but complications occur in a small number of patients. The most common are bruising or bleeding at the groin. Atrial fibrillation, an irregular fast rhythm, may appear in the first weeks and usually settles, sometimes needing temporary medication. Less common problems are bleeding into the sac around the heart, movement or, very rarely, dislodgement of the device requiring retrieval or surgery, clot forming on the device, infection, a small residual leak, or an allergic reaction. Stroke during the procedure is rare. Sedation and the gullet ultrasound have their own small risks, including a sore throat.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.