PFO Closure
A PFO closure uses a medical device to close an opening between your heart’s two upper chambers. You only need this opening as a fetus. After birth, when your lungs are working, this opening usually closes. When it stays open, it usually doesn’t cause issues. But in some cases, it does. PFO closure is an option for people whose PFOs cause problems.
A PFO (patent foramen ovale) closure plugs an opening between your heart’s two upper chambers by putting in a permanent device. A healthcare provider can do this using a catheter (a long, thin, flexible, hollow tube) that they get to your heart through a large vein elsewhere in your body.
Your provider can use a closure device to plug the opening. These devices have a wire frame that consists of a nickel-titanium metal alloy with synthetic material around it. Some look like a yo-yo, with two round disks and a narrow middle. Each round disk covers one side of the hole in your heart.
Within a few days of receiving a PFO closure device, your body’s own tissue will start to grow over and around it. Three to six months later, your heart tissue completely covers the device. At that point, it becomes a part of your heart wall.
If you have a PFO larger than 25 millimeters, a provider will probably do PFO closure surgery instead of using the catheter method. This is rare.
A PFO closure plugs an opening (a foramen ovale) in your heart that usually closes at birth. As a fetus, you need a PFO (patent foramen ovale) to allow blood to flow from your right atrium (upper heart chamber) to your left atrium. But you don’t need it after birth because your lungs are breathing oxygen instead of taking it from your birth mother's blood.
The PFO closure device will stay in your heart permanently to stop the abnormal flow of blood between the two atrial (top) chambers of your heart.
A healthcare provider may recommend a PFO closure procedure if:
- You’ve had a transient ischemic attack (TIA) more than once.
- You’ve had cryptogenic (from an unknown cause) strokes more than once.
- You have a low level of oxygen in your blood.
- You have migraines.
- You have decompression sickness.
- You’ve had a blood clot that traveled through the PFO and out to your body.
- A provider believes you’re at risk of a blood clot or cryptogenic stroke.
- A provider doesn’t think you should take anticoagulant drugs long-term.
It’s not common for people to need a PFO closure. About 25% of people have a PFO, but most people don’t need treatment for it.
You’ll need to get several tests before your procedure, like:
- Chest X-ray.
- Echocardiogram.
- Electrocardiogram (EKG).
- Blood tests.
To prevent blood clots, you’ll also need to start taking medicines like aspirin and clopidogrel before your PFO closure. Your provider will tell you when to start taking these. During your procedure, your provider will also give you heparin to prevent blood clots.
During a PFO closure, a provider will:
- Use a local anesthetic to numb the groin area where they’ll insert the catheter. They may also use general anesthesia or intravenous (IV) sedation, depending on the situation.
- Make a small incision (cut), usually in the inner thigh (groin area).
- Insert a catheter into a large vein through the incision.
- Slowly advance the catheter into your heart.
- Use angiography (an injection of a certain type of dye followed by an X-ray motion picture) to get a better view of your heart.
- Use ultrasound imaging from inside your esophagus or inside your heart to see the PFO better. It also helps them decide the size of the closure device you need.
- Move a special balloon on a catheter to the area of the hole.
- Inflate the balloon to measure the size of the hole.
- Move a PFO closure device through your vein to your heart.
- Place the PFO closure device in the heart wall opening so that it straddles each side of the hole.
- Check to make sure the device is in the correct position by using a transthoracic echocardiogram.
- Remove the catheter.
How long does PFO closure procedure take?
The cardiac catheterization procedure for a PFO closure typically takes one to two hours.
Within 24 hours after the procedure, a provider will do tests to make sure your PFO closure device is in the right place. Tests include:
- Chest X-ray.
- Electrocardiogram (EKG).
- Echocardiogram.
Before you leave, your provider will prescribe medications for you to take at home. You’ll need to take aspirin or other blood-thinning drugs like clopidogrel every day for six months or longer to prevent blood clots from forming.
You’ll need to take antibiotics one hour before certain medical procedures (like dental cleaning, dental surgeries and other surgeries) for up to six months after you receive the device. Your provider will tell you which procedures will require antibiotic pre-treatment to prevent endocarditis. They may tell you to delay a dental procedure for six months instead.
Like all medications, take them only as directed. Never stop taking the medication without talking with your provider first. And call your provider if you have any unpleasant reactions to, or concerns about, the medicine.
Benefits of PFO closure include:
- It may prevent future strokes with an unknown cause.
- You won’t be able to feel the device.
- You won’t have a scar.
- The materials in closure device products have a proven long-term history of safety.
- It’s not likely that your body will have a negative reaction to this device.
A study found a success rate of about 96% for implanting a PFO closure device in hundreds of people without serious complications.
Risks or complications of PFO closure may include:
- Atrial fibrillation (afib) or another type of abnormal heart rhythm (arrhythmia).
- Issues with blood vessels involved in the procedure.
- Blood clot.
- Death.
- Cardiac tamponade.
- Pneumothorax (collapsed lung).
- The device moving out of place.
- Minor pain at the catheter incision site.
Healthcare providers don’t consider a PFO closure a risky procedure. This is especially true when an experienced provider performs it. Still, about 7% of people with a PFO closure have complications. They’re more likely to happen if you’re older than 60.
You’ll need to rest in bed in the hospital for six hours after patent foramen ovale closure. You may go home the evening of the procedure or the following morning.
After you go home:
- You can walk right away, but not briskly.
- Wait two days before driving again.
- Avoid lifting anything heavier than 10 pounds for one week after the procedure.
- Wait one month before doing strenuous exercise or lifting 20 pounds.
- Go back to your regular activities within a week (in most cases). Check with your provider about your specific situation.
You’ll need a few follow-up visits over the next year to monitor your heart and the device’s placement. These appointments will be one month, six months and one year after your procedure. Each visit will include a chest X-ray, electrocardiogram and echocardiogram.
Some researchers say a PFO closure doesn’t reduce your stroke risk much more than medication.
But others have found that having a catheter-based procedure for PFO closure and taking blood-thinning drugs like aspirin gives people a lower rate of stroke than people who received only aspirin. People who had a PFO closure had a risk of stroke at least 45% lower than people who took the medicine but didn’t have a procedure.
When should I call my healthcare provider?
Contact your provider if you have signs of the complications in the list above. This may include bleeding or signs of infection in the area where they put the catheter.
References
- Brown KN, ElBebawy B, Shah AH, et al. Catheter Management of Patent Foramen Ovale (https://pubmed.ncbi.nlm.nih.gov/30725999/). 2023 Mar 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 1/25/2024.
- Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke (https://pubmed.ncbi.nlm.nih.gov/23514286/). N Engl J Med. 2013 Mar 21;368(12):1092-1100. Accessed 1/25/2024.
- Kent DM, Dahabreh IJ, Ruthazer R, et al. Device Closure of Patent Foramen Ovale after Stroke: Pooled Analysis of Completed Randomized Trials (https://pubmed.ncbi.nlm.nih.gov/26916479/). J Am Coll Cardiol. 2016 Mar 1;67(8):907-917. Accessed 1/25/2024.
- Lee DP, Perry SB. Percutaneous Closure of Atrial Septal Defect and Patent Foramen Ovale. In: Samady H, Fearon WF, Yeung AC, King III SB, eds. Interventional Cardiology. 2nd ed. McGraw Hill; 2017.
- MacGrory B, Ohman EM, Feng W, et al. Advances in the management of cardioembolic stroke associated with patent foramen ovale (https://pubmed.ncbi.nlm.nih.gov/35140114/). BMJ. 2022 Feb 9;376:e063161. Accessed 1/25/2024.
- Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism (https://pubmed.ncbi.nlm.nih.gov/23514285/). N Engl J Med. 2013 Mar 21;368(12):1083-1091. Accessed 1/25/2024.
- Society for Cardiovascular Angiography & Interventions. Patent Foramen Ovale Closure (https://www.secondscount.org/treatment/patent-foramen-ovale-pfo-closure). Last reviewed 11/8/2022. Accessed 1/25/2024.
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