The 2 atria of the heart are separated by a wall of tissue called the interatrial septum. During fetal life, this wall allows the blood to circulate through a channel, the foramen ovale, that closes at birth. It can remain patent in 25-30% of cases. Thus, it is not considered a disease but a variant of normal.
In certain situations causing pressure differences, such as when we squat or perform exercises involving abdominal compression (e.g. sit-ups), the functionally closed PFO can transiently open. While not generally altering the well-being and physical performance of an individual, a PFO can occasionally be responsible for a stroke or other clinical incidents. Indeed, when the PFO opens, a blood clot arising from the venous circulation and reaching the heart can pass through the orifice and lead to blood vessel occlusion in the brain causing stroke. In rare cases, PFOs are responsible for decompression accidents of divers or poor oxygenation of the blood (platypnea-orthodoxia syndrome). In these 3 cases, we can propose non-surgical endovascular PFO closure.
How does a PFO closure take place?
A 72-hour hospitalization is required. In order to avoid infections, a hygiene protocol is necessary, whereby a shower using an antiseptic product and shaving of both groins is requested.
You will be accompanied from your room to the coronary angiography laboratory by a patient attendant.
PFO closure is performed in the catheterization laboratory, in a sterile environment, with the presence of the interventional cardiologist, the cardiologist performing the transesophageal echocardiography and the anesthesiology team.
After being positioned on the examination table, a medication will be given by the anesthesiologist to relax you throughout the entire exam.
The closure device is introduced through the femoral vein located at the groin crease. It consists of 2 Nitinol disks connected by a metal strut (e.g. like a clam shell) whose positioning is guided by X-rays and transesophageal echocardiography.
After the procedure, cardiac monitoring will be continued until the next day. You will need to lie down for 4 consecutive hours with a pressure dressing applied on the puncture site.
The day following the intervention, an electrocardiogram and a transthoracic echocardiography will be performed. In absence of complication, you will be discharged the following day of the intervention. Barring exceptions, you will resume a normal life after just a few days. Upon follow-up with your cardiologist, routine echocardiography will be performed in order to insure proper functioning of your closure device.
For the vast majority of patients, this procedure is painless.
Is it dangerous?
Complications related to PFO closure are mostly benign and local, such as bleeding or hematoma at the venous puncture site. The most frequent complication (3.4%) is the occurrence of rhythm abnormalities (atrial fibrillation) in the weeks following the intervention. Severe complications are rare and occurs in less than 1% of cases (air embolism, migration of the prosthesis, tamponade). All the potential complications are fully detailed in the informed consent form for the exam given upon admission and to be signed before the procedure.
- Hospitalization for 72 hours.
- Mean duration of the intervention: 30 minutes
- The procedure is performed under general anesthesia.
- A 4-hours immobilization period following the cardiac catheterization is required in order to avoid bleeding at the puncture sites.
- Discharge the next day following an echocardiography and electrocardiogram.
- Strenuous physical effort is discouraged for 72 hours following the procedure to avoid bleeding at the radial and/or femoral puncture site.