Being told you have a patent foramen ovale (PFO) can be worrying, especially if it has been discovered after a stroke or transient ischaemic attack (TIA). Fortunately, PFO closure is now a routine, minimally invasive procedure that is highly effective in carefully selected patients.
From diagnosis through to recovery, every stage of the process is carefully planned to ensure the procedure is as safe, comfortable and straightforward as possible. Understanding what to expect can help you feel more confident about your treatment and recovery.
No open-heart surgery required
One of the biggest advantages of modern PFO closure is that it does not require open-heart surgery.
Instead, the procedure is performed using a thin, flexible tube called a catheter, which is inserted through a small puncture in the vein at the top of the leg (groin). The catheter is carefully guided through the blood vessels to the heart using X-ray imaging and ultrasound, allowing your cardiologist to reach the PFO without making any large incisions.
Although this sounds complicated, it is a well-established procedure performed regularly in specialist heart centres.
Most patients have the procedure under general anaesthetic, as this enables the use of a transoesophageal echo (TOE), an ultrasound probe inserted into the gullet, which gives very detailed pictures of the heart. In select patients it can also be done under local anaesthetic with light sedation.
Because there is no large surgical wound, recovery is much quicker, discomfort is usually minimal and the risk of complications is lower than with traditional heart surgery.
Closing the PFO
Once the catheter reaches the heart, a specially designed closure device is passed through it to the PFO.
The device is made of two small discs attached together by a narrow waist. One disc opens on each side of the PFO, gently sealing the opening between the upper chambers of the heart. Once your cardiologist is happy that the device is in the correct position, it is released and left in place permanently.
Throughout the procedure, ultrasound imaging is used to ensure the device is positioned accurately before it is detached from the catheter.
Although every patient is different, the procedure itself usually takes less than an hour.
Over the following weeks and months, your own heart tissue gradually grows over the device. Eventually, it becomes incorporated into the wall of the heart, creating a permanent seal while allowing the heart to continue functioning normally.
Recovery: can I go home the same day?
For many people, the answer is yes.
PFO closure is commonly performed as a day-case procedure, meaning you can often return home later the same day after a few hours of observation. Some patients stay overnight, depending on their medical history or how they recover after the procedure.
Before you go home, your heart rhythm, blood pressure and the catheter insertion site will be checked to make sure everything is as expected, along with an echocardiogram to ensure there are no immediate issues after the procedure.
Most people feel well enough to resume light daily activities within a day or two. Driving, heavy lifting and strenuous exercise are avoided for about a week, while the puncture site heals.
You will also be prescribed medication, usually aspirin or another antiplatelet medication like clopidogrel, for several months after the procedure. This helps reduce the risk of small blood clots forming on the device while it becomes covered by your own heart tissue.
Follow-up appointments, including an echocardiogram, are arranged to confirm that the device is securely in place and that the PFO has been successfully closed.
The long-term outlook
The main reason for closing a PFO is to reduce the risk of another stroke in carefully selected patients who have had a stroke or TIA without another identifiable cause.
The PFO provides a potential pathway for a blood clot to pass from the right side of the heart to the left, where it can travel to the brain and cause a stroke. Closing the opening removes this pathway, helping to reduce the risk of future events.
Once the device has become fully incorporated into the heart, most patients can return to their normal lifestyle without any long-term restrictions related to the procedure. The device remains permanently in place and is designed to last a lifetime.
If you have been diagnosed with a PFO or have experienced an unexplained stroke or TIA, a specialist assessment can determine whether PFO closure is the right treatment for you. Our team can explain the procedure, answer your questions and guide you through every stage of your care.