Interventional Procedures

Percutaneous PFO Closure

A patent foramen ovale (PFO) is a small flap-like opening between the upper chambers (atria) of the heart that did not fully close after birth. Many people never know they have one, but in some cases it may be linked to stroke, migraine with aura, or decompression illness in divers.

What is Percutaneous PFO Closure?

Percutaneous (“through the skin”) PFO closure is a minimally invasive procedure used to seal the opening without open-heart surgery.

A cardiologist inserts a thin tube (catheter) into a vein in the groin and guides it to the heart. A closure device is then placed across the PFO to block the passage between the atria. Over time, heart tissue grows over the device.

The most common reason is prevention of another stroke in selected patients who have had a:

  • Cryptogenic stroke, sometimes called Embolic Stroke of Undetermined Source (ESUS) — an ischaemic stroke with no other clear cause
  • PFO believed likely to have contributed to the stroke

Other possible indications may include:

  • Embolic heart attack with normal coronary arteries
  • Certain cases of decompression sickness in divers

Not everyone with a PFO needs closure. Many people have a PFO and never need it closed.

What Happens Before the Procedure?

Before closure, patients usually undergo:

  • Brain imaging (if stroke has occurred)
  • Heart imaging such as an echocardiogram (transthoracic and/or transoesophageal)
  • Bubble contrast echocardiogram to confirm shunting
  • Blood tests and ECG
  • Review by a cardiologist and often a neurologist

During the Procedure

The procedure is performed in a cardiac catheterisation laboratory, usually under general anaesthesia.

Typical steps:

  1. You lie on an X-ray table.
  2. A catheter is inserted into a vein in the groin.
  3. X-ray and transoesophageal echocardiogram (a probe passed into the oesophagus) guide the catheter into the heart.
  4. The closure device is positioned across the PFO.
  5. The device is released once placement is confirmed.

The procedure commonly takes about an hour.

Benefits

In appropriately selected patients, PFO closure can:

  • Reduce the risk of recurrent stroke
  • Eliminate abnormal shunting between the atria
  • Avoid long-term uncertainty about the embolic source

Risks and Complications

PFO closure is generally safe, but risks can include:

  • Bleeding or bruising at the groin site
  • Abnormal heart rhythm (rare)
  • Device movement or embolisation (rare)
  • Blood clots forming on the device
  • Infection
  • Allergic reaction to contrast dye
  • Stroke, heart injury, or death (very rare)

Most complications are uncommon.

Recovery

Most patients:

  • Stay in hospital overnight
  • Return to normal activities within a few days
  • Avoid heavy lifting for about a week

You will usually need:

  • Aspirin long-term
  • A second antiplatelet medicine such as clopidogrel for several months
  • A follow-up bubble contrast echocardiogram to confirm the result
  • Temporary antibiotics before certain procedures in selected cases

When to Seek Urgent Medical Care

Seek immediate medical attention after the procedure if you develop:

  • Chest pain
  • New neurological symptoms (weakness, difficulty speaking, or vision changes)
  • Fever or signs of infection
  • Significant bleeding from the groin site