What is a PFO?
PFO (patent foramen ovale) is a communication between the right and left atria that fails to fuse after birth and a flap is present that can open and close under certain pressure gradients in the chest. PFO is present in 20-34% of the adult population and is benign for most. In others, a paradoxical embolus (blood clot) from the venous circulation can travel through the PFO allowing it to enter the arterial circulation and cause a stroke or other systemic embolization.
Why close the PFO?
PFO closure has been shown to significantly reduce the risk of stroke in patients with cryptogenic stroke (other causes ruled out) compared with medical therapy alone (demonstrated in the latest RESPECT, CLOSE & REDUCE trials). It does not reduce your stroke risk to 0%. As you age, there will be other reasons for stroke.
Who is a candidate for PFO closure?
Patients who have had a cryptogenic stroke, meaning all other causes for stroke have been ruled out. Patients will need a full workup prior to closure including:
- Transesophageal echocardiogram - to assess the anatomy of the PFO and determine if it’s suitable for transcatheter approach
- 30 day loop monitor- to rule out any arrhythmias (atrial fibrillation) as a possible cause for stroke
- Hypercoagulable workup (blood tests) – to rule out a clotting disorder that would increase your chance of stroke
- Neurology consult recommending PFO closure is indicated
What does the procedure involve?
This is a same day procedure. It is done under general anesthesia. They place an echocardiogram probe into your esophagus during the procedure to help guide placement of the closure device (transesophageal echocardiogram). The device is placed at the end of a catheter that is placed through the vein in your groin (femoral vein). The catheter is guided to the heart through the PFO. The device is deployed on both sides of the defect sealing the PFO. The catheter is removed and you are brought to the recovery area. You will be monitored for several hours post procedure. An echocardiogram is done prior to discharge that day.
What to expect post discharge
- There is limited down time required post procedure. Light activity is recommended for two weeks post procedure to allow the groin site to fully heal.
- You will be started on Aspirin and Plavix for dual antiplatelet therapy for 6 months post closure. The Plavix can be stopped after 6 months. You will remain on Aspirin indefinitely. This prevents any blood clots from forming on the device while it heals and endothelializes (tissue grows over device).
- You will require a transthoracic echocardiogram at 30 days post procedure either at Hartford Hospital or with your cardiologist.