A patent foramen ovale (PFO) is a small hole between the two upper chambers of the heart, the right and the left atrium. Patent foramen transcatheter repair is a procedure to fix this hole in the heart.
Normally, the atrial septum separates the right and left atria. No blood flows between these 2 chambers. If a PFO exists, a little blood can flow between the atria. This flow of blood between the atria is not normal. This hole is normally present in the heart before birth. But in most people, it closes soon after birth.
During transcatheter repair, a healthcare provider inserts a device that can plug up the PFO. This device attaches to the end of a long, flexible tube called a catheter. The healthcare provider inserts the catheter through a blood vessel in the groin and guides it to the PFO. He or she uses the device to fix the hole and then removes the catheter from the body.
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 traveling blood clot that blocks a blood vessel in the brain. PFOs do not cause most strokes, but having a PFO may slightly increase the risk for stroke in some people.
You usually do not need treatment if you have no risk factors for stroke or any history of traveling blood clots. Your healthcare provider may want to treat your PFO if you have had problems, such as strokes from these traveling blood clots.
Treatment for PFOs in these cases varies. In some cases, your healthcare provider may still choose not to treat the PFO. Another choice is treatment with antiplatelet medicines such as aspirin. Or you may take anticoagulant medicines such as warfarin. These can help prevent blood clots. Your healthcare provider may also the PFO by transcatheter repair or heart surgery.
A transcatheter repair is less invasive than a surgical repair. You usually recover more quickly. Your healthcare provider might be less likely to recommend this treatment if you need surgical repair for another heart problem in addition to the PFO. Ask your healthcare provider what treatment is best for you.
Complications are very rare with this procedure. But they do sometimes happen. Risk factors may vary based on age, the size of the defect, and other health problems. Possible risks include:
- Abnormal heart rhythms. These can cause sudden death in rare instances.
- Device becoming unattached and traveling through the heart or vessels
- Tear in the blood vessels around the heart
- Excess bleeding
- Puncturing of the heart (rare)
There is also a risk that the procedure will not fix the PFO. Ask your healthcare provider about your specific risks.
Ask your healthcare provider about how to get ready for this procedure. You should not eat or drink anything after midnight before the day of the procedure. You may also need to stop taking any medicine beforehand.
Your healthcare provider may want some extra tests before the procedure. These might include:
- Chest X-ray
- Electrocardiogram to look at your heart rhythm
- Blood tests to check general health
- Echocardiogram to look at the heart anatomy and blood flow through the heart
- Transcranial and transmitral Doppler to see the blood moving through the heart
- Bubble study that is used with the 2 above tests to view the PFO
Hair from around the catheter insertion site may be removed before the procedure.
Talk with your healthcare provider about what to expect. Your procedure may vary depending on the kind of echocardiogram the healthcare provider uses. A cardiologist and a team of specialized nurses will do the procedure, usually in a cardiac catheterization lab. In general:
- A healthcare provider will probably give you anesthesia before the surgery starts. You will sleep deeply and painlessly during the operation. You won’t remember it afterward.
- The repair will take about 2 hours.
- The healthcare provider inserts a small, flexible tube (catheter) into an artery in the groin. This tube will have a small device inside it.
- The provider threads the tube through the blood vessel all the way to the PFO.
- The provider may use X-ray images and an echocardiogram to see exactly where the tube is.
- The provider will push the small device out of the tube and plug the hole in the PFO. Then the device will be secured in place.
- The provider will remove the tube through the blood vessel.
- The insertion site will be closed and a bandage will be applied.
Talk with your healthcare provider about what will happen after your repair. You can generally expect that:
- You will spend several hours in a recovery room.
- Your vital signs will be closely watched. These include your heart rate, blood pressure, oxygen levels, and breathing.
- You may need to lie flat for several hours after the procedure without bending your legs. This position will help prevent bleeding.
- Your healthcare provider might prescribe medicine to keep your blood from clotting.
- You may get pain medicine if needed.
- Your healthcare provider may order follow-up tests, like an electrocardiogram or an echocardiogram.
- You may be able to go home the same day as the procedure. Make sure you have someone who can drive you home.
At home after the procedure:
- Ask what medicine you need to take. You may temporarily need to take antibiotics or medicines to prevent blood clots. Take pain medicine as needed.
- You can resume your normal activities fairly quickly. But avoid strenuous activities.
- If you have any stitches or staples, you will have them removed in a follow-up appointment. Be sure to keep all follow-up visits.
- Call your healthcare provider if you have increased swelling, increased bleeding or drainage, a fever, or severe symptoms.
- Follow all the instructions your healthcare provider gives you about medicines, exercise, diet, and wound care.
- Your healthcare provider will probably order a follow-up bubble study several months after the procedure to ensure that the PFO remains closed.
For a while after the procedure, you may also need to take antibiotics before certain medical and dental procedures. It will help prevent an infection of the heart valves. Ask your healthcare provider if you will need to do so.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Treatment of atrial septal abnormalities (PFO, ASD, and ASA) for prevention of stroke in adults. UpToDate, Patent foramen ovale. UpToDate
Sudheendra, Deepak, MD,Fetterman, Anne, RN, BSN