Patent Foramen Ovale (PFO) Closure

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What is a Patent Foramen Ovale (PFO) Closure?

The Foramen Ovale is a flap-like opening or hole between the two upper chambers of the heart known as the left and right atria. In the womb, all babies have this opening because it makes circulation more efficient during development. However, after birth the hole normally closes to form a solid wall (called the septum) between the chambers. If it does not close properly at birth, the hole is called a Patent Foramen Ovale (PFO). Commonly, you may have heard it referred to as ‘a hole in the heart.’ A PFO can permit blood to pass unfiltered from the right atrium to the left atrium and out into the body, including the brain.

A PFO is typically closed with a minimally invasive procedure called a PFO Closure which is performed under local anaesthetic. During the procedure, a PFO closure device is implanted into your heart.

If I have a PFO, will I definitely need a closure surgery procedure?

PFO affects about 25% of the general worldwide population, or about 1 in 4 people. Some people don’t even know they have it or require any treatment; for the vast majority of people with a PFO, it is not a problem. However problems can arise when that blood contains a blood clot. In some cases, the PFO combines with another condition, such as atrial fibrillation (AFib), to increase the patient’s risk of stroke. In these cases, a PFO Closure procedure is recommended.

Can a PFO cause migraines and other symptoms?

Usually a patent foramen ovale is diagnosed when tests are done for another health concern. If your doctor thinks you may have a PFO, imaging tests of the heart may be done.
Several clinical experiences have shown a potential association between the presence of a PFO and patients who suffer migraines or have experienced a stroke of undetermined cause (called a cryptogenic stroke). Some studies have found that up to 40% of migraine sufferers have a PFO.

The reason for the link between the presence of a PFO and the incidence of migraine and stroke is currently unknown. Some research suggests that the unfiltered blood that is allowed to pass into the left atrium through the PFO may trigger migraines or may cause blockage to the artery in the brain, resulting in a stroke.

Research study evidence shows that closing the PFO can decrease the frequency of migraines or reduce the risk of having a stroke, and there are active clinical trials exploring the effects of the PFO and benefits of the closure procedure.

Can a PFO cause migraines and other symptoms?

Usually a patent foramen ovale is diagnosed when tests are done for another health concern. If your doctor thinks you may have a PFO, imaging tests of the heart may be done.
Several clinical experiences have shown a potential association between the presence of a PFO and patients who suffer migraines or have experienced a stroke of undetermined cause (called a cryptogenic stroke). Some studies have found that up to 40% of migraine sufferers have a PFO.

The reason for the link between the presence of a PFO and the incidence of migraine and stroke is currently unknown. Some research suggests that the unfiltered blood that is allowed to pass into the left atrium through the PFO may trigger migraines or may cause blockage to the artery in the brain, resulting in a stroke.

Research study evidence shows that closing the PFO can decrease the frequency of migraines or reduce the risk of having a stroke, and there are active clinical trials exploring the effects of the PFO and benefits of the closure procedure.

How do I prepare for a PFO Closure procedure

You will be asked to fast (no food or drink) for six hours prior to the procedure.

Your cardiologist will advise if there is to be any change to your usual medication prior to the procedure. If your doctor has advised you to take your usual medication, take this early on the morning of the procedure with just a small amount of water.

The following tests may be performed prior to or as part of the procedure:

  • Echocardiography
  • Right Heart Catheter – After an injection of local anaesthetic, a soft balloon catheter is put into the vein in your groin. The tube is passed along until it reaches the heart and then goes up into the blood vessels of the lung. The pressures in the lungs and heart are recorded.
  • Coronary Angiography 
  • CT Coronary Angiogram

What happens during a PFO Closure procedure

The PFO Closure procedure is performed under local anaesthetic, meaning you will be awake throughout it, however will not feel anything After a small incision is made in the groin and a long, thin tube called a catheter is inserted into a vein. The PFO closure device is then guided through the catheter to the heart. Once there the device is implanted, or anchored, and then adjusts to the unique anatomy of your heart.

Soon after the PFO closure device is implanted, tissue begins to form and eventually cover the device completely. This process of tissue formation is medically known as endothelialisation. It is important because it helps prevent blood in the left atrium from reacting with the exposed device and forming clots (called thrombosis).

What happens after a PFO Closure procedure

Patients are generally discharged from hospital the day after the procedure. You will be reviewed by your doctor prior to discharge. One of our staff members will be in contact with you to arrange a follow-up appointment in the rooms in the near future.

Remote Monitoring Service

QCG offers a remote monitoring service that enables ‘virtual check-ups’ for your implanted device. This allows you to directly and securely transmit data from your device to your cardiologist from the comfort of your own home. This enables us to detect significant events such as an abnormal heart rhythm, monitor the performance of your device such as battery life, and optimise your care through device programming or medication change.

Your participation in remote monitoring allows us to follow your device function between visits, and in some situations, it may replace office visits. This means less time spent at the doctor’s office for regular checks, faster time to treatment if your cardiologist detects a medical problem and faster troubleshooting if a problem is detected with your device. Research evidence has shown that early detection of issues through remote monitoring leads to improved health outcomes and a reduced risk of hospital admission. It also allows you to monitor your own heart rhythm and quickly detect any irregularities or arrhythmias.

For more information visit Remote Monitoring Service.

PFO Closure Frequently Asked Questions

Most PFOs do not cause any symptoms and do not need any treatment. But sometimes PFOs can lead to complications. The most significant of these is stroke. Stroke can result from a travelling blood clot that crosses over the PFO from the venous circulation to the arterial circulation that then blocks a blood vessel in the brain.

PFO closure is generally considered a safe and effective procedure, and serious complications are rare. However, as with any medical procedure, there are risks involved, and these should be discussed with your doctor before the procedure.

Some possible complications of PFO closure include:

Bleeding: There is a small risk of bleeding at the site of the catheter insertion.

Infection: There is a small risk of infection at the site of the catheter insertion or in the heart.

Blood clots: There is a small risk of blood clots forming in the catheter or in the heart, which can lead to stroke or other complications.

Arrhythmia: There is a small risk of developing an irregular heartbeat after the procedure.

Device-related complications: In some cases, the device used to close the PFO can shift or become dislodged, requiring additional procedures to fix it.

Allergic reaction: There is a small risk of having an allergic reaction to the materials used in the PFO closure device.

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