Patent foramen ovale (PFO) closure Innovative surgery with a rapid recovery time

The foramen ovale is a small hole between the upper right and left chambers (atria) of your heart. When we are in the womb, we don’t breathe through our lungs, but get oxygen from our mother’s placenta through the umbilical cord. The foramen ovale allows this oxygen-rich blood to pass through both upper chambers of the heart before birth.

In most people, when we take our first breath into our lungs, the foramen ovale closes, but in around 25% of people, this doesn’t happen and the hole remains open or “patent”. This condition is known as patent foramen ovale, or PFO.

Most people with patent foramen ovale don’t experience any symptoms and the foramen ovale doesn’t need to be closed, but in some people, blood clots can pass through the foramen ovale and travel to the brain causing a stroke. In this case, a procedure to close the foramen ovale may be recommended to reduce the risk of a further stroke.

Patent foramen ovale (PFO) closure is a procedure to close the foramen ovale (the hole between the atria in your heart). During the procedure, a flexible tube called a catheter is passed through a vein in your leg and guided to your heart using X-rays and ultrasound imaging. A special closure device is then used to close the hole. 

What happens during patent foramen ovale (PFO) closure?

Patent foramen ovale (PFO) closure is performed under local anaesthetic, which means you’ll be awake during the procedure, but won’t feel any pain. You may also be given a mild sedative to help you relax during the procedure.

• Once the local anaesthetic has taken effect, your consultant will find the main vein at the top of your leg (the femoral vein) with a special needle, guided by ultrasound. Two fine, flexible tubes called catheters are inserted into the vein.
• Your consultant then inserts a fine ultrasound probe into one of the catheters. This probe acts like a camera and guides your consultant, ensuring the catheters are in the correct place at all times during the procedure.
• Once the catheter has reached your heart, your consultant will examine your heart from the inside using a procedure called an intracardiac echo (ICE) to check for any defects.
• Next, a soft balloon is inserted into the other catheter. When it reaches your heart, the balloon is inflated to allow your consultant to measure the size of the hole and select the correct size closure device.
• The catheter with the balloon is removed, and the most appropriate sized device is inserted using a separate catheter. Ultrasound and X-rays are used to make sure the device is in the correct place.
• The catheters are removed, and the incision is stitched closed.
• You will receive other medicines including a blood thinner and a single dose of antibiotic

Patent foramen ovale (PFO) closure takes around one hour. 

Most people with PFO don’t have any symptoms and the condition often doesn’t require treatment. However, in some cases, a blood clot can pass through the open foramen ovale and travel to the brain, causing a stroke or mini-stroke. If you have had a previous stroke due to your PFO, or if your PFO is large, or causes symptoms, your consultant may recommend patent foramen ovale (PFO) closure.

Your consultant will tell you all you need to know to prepare for your PFO closure. This may include stopping certain medications, like blood thinners, for a few days before the procedure. You can continue to eat and drink on the day of your procedure. Your consultant will advise you more about this.

Before your patent foramen ovale (PFO) closure, your consultant may order tests to check your general health and the health of your heart, including a chest X-ray, blood test, echocardiogram or electrocardiogram (ECG).

We recommend you don’t drive for the first three days after your procedure and avoid strenuous exercise or activities, such as heavy lifting, for the first week. You can resume activities such as walking and light housework the following day. Most people take between three days and a week off work after patent foramen ovale (PFO) closure, depending on the type of job you do. We advise waiting a week before flying. You should talk to your consultant if you take part in contact sports because you will need to take a blood thinner for some time after treatment. Your consultant will help advise you how on best to tailor your treatment.

Your consultant may recommend patent foramen ovale (PFO) closure if you:

• Have been diagnosed with patent foramen ovale (PFO)
• Have had a previous cryptogenic stroke (a stroke of unknown cause)
•  Are around the age of 60 or younger

The main alternative to PFO closure is with medications called anticoagulants (blood thinners). These medicines help to prevent blood clots, which can reduce the risk of having a stroke. 

We don’t usually recommend open heart surgery to treat a PFO on its own but if there are other problems with your heart that need an operation (such as an enlarged blood vessel or faulty valve) a PFO could be closed by your surgeon at the same time.

Patent foramen ovale (PFO) closure has many benefits, including:

• Reduces the risk of stroke by preventing blood clots passing through the PFO and travelling to the brain
• Has been shown to be more effective than medication in preventing future strokes
• Has a lower risk of complications and a faster recovery time compared to open heart surgery 
• The procedure is minimally invasive, with no large incisions 
• Fast recovery time — most people are back to normal activities after a week
• No need for general anaesthetic
• No hospital stay required