Patent Foramen Ovale Closure

Overview

The foramen ovale is an opening, similar to a small flap, between the heart's top left and right chambers (atria). Everyone is born with this opening, which is essential to the blood flow of the developing fetus. After birth, this opening generally seals itself closed within a few months as the heart begins its normal function of pumping blood on its own, no longer needing to receive oxygen from the mother’s blood supply.

In up to 25% of individuals, the opening doesn’t close and remains open, called a patent foramen ovale (PFO). In most cases, the PFO causes no problems, and a person goes on to live a normal, healthy life. However, in some cases, a PFO has been linked to other health issues, such as ischemic stroke.

One method of reducing the risk of stroke is to close the PFO so that blood can no longer move across the heart through the PFO. If the PFO is closed, a clot forming on the venous side can’t cross through the PFO, and instead of going to the brain, it would end up in a branch of the lung arteries, where these small clots will dissolve naturally. A small clot in the lungs is well tolerated and often unnoticeable, while the same clot can lead to a major disability if it lodges in the brain or other organs. The PFO can be closed off in two ways: surgical repair and device closure. However, with current transcatheter devices available, open surgical repair is rare.

Transcatheter PFO closure

One option for closing the PFO without open-heart surgery is using a small occluder device (designed to stop blood flow through the PFO) inserted into the heart through a vein less invasively than open-heart surgery would be. This is known as transcatheter closure of the PFO. It’s a procedure that was first used successfully in 1989 and has become the treatment method of choice since that time.

The U.S. Food and Drug Administration (FDA) has approved using devices to close a PFO to reduce the risk of stroke in cases where a patient has suffered at least one cryptogenic stroke, meaning the patient has been examined by a neurologist and a cardiologist. It’s been determined that the stroke can’t be traced back to other risk factors or causes, such as atrial fibrillation (Afib), carotid artery disease, etc.

How transcatheter PFO closure works

A trained professional, an interventional cardiologist, inserts a small occluder device into the body through a long catheter via a small puncture in the femoral vein in the groin area and guides the device up to the heart by using fluoroscopy. Echocardiography, specifically a transesophageal echocardiogram (TEE), passes an echotransducer (a device that produces high-frequency sound waves) down the food pipe (esophagus) to look closely at the heart valves and chambers to check for abnormalities, or an intracardiac echocardiogram (ICE), a catheter-based form of echocardiography that gathers images from within the heart is used to help verify the position and function of the device during the procedure.

When TEE is used by the interventional cardiologist, light sedation is administered in adults during the procedure. General anesthesia (meaning the patient sleeps through it) is typically used for children. If ICE is used, only moderate sedation is required (medicine is given to calm and relax the patient). In either case, the procedure takes 30–90 minutes and usually requires one day in the hospital for observation and recovery.