Having a patent foramen ovale (PFO) closure?
This leaflet aims to answer your questions about having the hole in your heart (known as a patent foramen ovale, or PFO) closed. It explains the benefits, risks and alternatives to having the procedure, as well as what you can expect when you come to hospital.
If you have any further questions or concerns, please speak to a doctor caring for you.
What is a PFO?
You have been diagnosed with a patent foramen ovale (PFO). This is a hole that babies have in their heart when they are in the womb, but that usually closes naturally after birth. However, in as many as one in four people it does not close completely and remains ‘patent’ (open). The hole is in the wall that divides the upper two chambers in the heart which collect the blood returning from the body. In most people the hole does not cause any problems, but in some people it can lead to strokes.
What happens during a PFO closure?
A small device made up of two umbrellas joined at the centre is put into the hole to close it up. The procedure normally takes around an hour including anaesthetic and is performed under general anaesthetic, which means you will not be awake and will not feel any pain.
Before the surgeon starts to repair the hole, the doctors will assess it using a small ultrasound probe that is put down your throat. This probe is known as a ‘transoesophageal echocardiogram’. At times we may also look at the heart using another type of ultrasound called ‘ICE’, which is inserted into a vein in your groin using a catheter (fine tube).
Once the team is happy that they can close the hole, a catheter will be inserted into a vein in your groin. The catheter is then passed to your heart.
The device is folded so it can fit through a long tube called a ‘sheath’. It is then put through the catheter in your groin and passed to your heart. We use the probe in your throat and x-rays to make sure the device is in the correct position, so that the two umbrellas open on either side of the hole in the heart, thus closing it.
Why should I have a PFO closure?
The treatment aims to close the hole in your heart, preventing you from having further strokes.
What are the risks?
The device may not hold in place. When the device is opened and released, there is a small chance it may dislodge because the tissue/rim around the hole is floppy. This happens in less than 1 in 100 people. If this does happen we will try to retrieve the device, but it may be difficult to withdraw it fully back into the sheath. If we cannot retrieve the device, you may need to have an open-heart operation to remove it from the heart, and the hole would be closed at the same time by the normal surgical method.
During any procedure of this kind, there is the risk of a stroke caused by a blood clot or air passing from the sheath, through the bloodstream and to the brain. This occurs in less than 1 in 100 people. We minimise this risk by giving heparin during the procedure to keep the blood thin. Other precautions are also taken to reduce the likelihood of air passing through the heart.
You may get some bruising after the procedure, which could extend down your thigh. Some bruising is normal but if you are concerned you should seek medical advice.
What are the alternatives?
In the past, the only way of closing these holes was by an open-heart operation. During an open heart operation, the function of the heart and lungs is taken over by a bypass machine and the surgeon closes the hole directly with stitches or patch material. Surgery is a very successful and safe method, but it does leave a scar on the chest and does require up to 3 months of recovery.
In the last few years, the method described in this leaflet (operating through a catheter placed in your groin) has become available as an alternative to surgery.
You are free to choose between the surgical and the non-surgical methods to close the hole. Your decision will in no way affect the care you receive in our hospital, however current guidelines recommend percutaneous PFO closure over surgical closure in patients who have had a stroke.
How can I prepare for my PFO closure?
You will be contacted by a member of the cardiac team to arrange your admission.
Information about what you need to do and what you should bring with you can be found in the information sheet which will be sent to you before your admission. Your admission letter should give you instructions about taking your medicines before you come into hospital.
Will I feel any pain?
The procedure takes place under general anaesthetic, so you will not feel any pain during the procedure. After the procedure, you may experience some very mild discomfort in your groin (where the catheters were inserted) but this should quickly pass.
What happens after the procedure?
For the first few hours after your procedure you will be attached to a cardiac monitor. This is a machine that is mounted on the wall behind your bed. You will have stickers on your chest that will be wired up to the monitor. This allows us to see your heart rate and rhythm. Likewise we monitor the oxygen level in your blood using a small electrical sensor attached to your finger.
After we have closed the hole using the device you will need to stay a further night in hospital. The day after your procedure, you will have two heart scans known as an ‘echo’ and an ‘ECG’. If all is well you can then go home.
What do I need to do after I go home?
We recommend that you are accompanied by a friend or relative on your journey home.
A letter will be given give to your GP and other specialists involved in your care. This will detail what has happened to you in hospital and which tablets you are on. You will need to take aspirin, clopidogrel or other blood thinners to thin your blood and stop large clots forming on the device. How long you need to take these for will vary. Please make sure you know how long you should continue taking these medicines for before leaving hospital. You will be given a card explaining why you are taking this combination, and for how long you should take them.
When you go home you should be back to full activity, including driving, within the week. If you have a physical job we will advise you on when you can go back to work.
Will I have a follow-up appointment?
We will invite you back to the clinic three months after the procedure. Providing all is well, you will then need to come back for yearly check-ups an transthoracic echocardiography. If you have any questions, please do not hesitate to ask us.
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