Patent foramen ovale (PFO) closure: Overview
The foramen ovale (say "fuh-RAY-men oh-VAL-ee") is an opening in the heart's septum. This is the part that separates the upper right and left chambers (atria) of the heart. The foramen ovale normally closes after birth. But sometimes it stays open. This is called a patent (say "PAY-tunt") foramen ovale, or PFO. A PFO usually doesn't cause problems as the person gets older. But sometimes it can lead to problems such as a stroke. This can happen if a blood clot moves out of the heart and travels to the brain.
A PFO closure is a procedure that can help lower the risk of a stroke for some people. A device is used to close the opening so that blood and blood clots don't flow through the opening anymore. A thin, flexible tube called a catheter will be used to place the device in your heart.
You may be asleep for the procedure, or you may get a sedative to help you relax. Your doctor makes a small cut in your groin. Then the catheter, with tools inside it, is put into your blood vessel and carefully guided to your heart. Your doctor moves the tip of the catheter to place a small device inside the PFO. The device expands and closes off the opening. It stays inside your heart. The catheter is then removed. In time, your heart will heal around the device. A layer of heart tissue will help seal off the PFO.
You may spend the night in the hospital, or you may go home the same day.
After patent foramen ovale (PFO) closure: When to call
Call 911 anytime you think you may need emergency care. For example, call if:
- You passed out (lost consciousness).
- You have symptoms of a stroke. These may include:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
Call your doctor now or seek immediate medical care if:
- Your heartbeat feels very fast, skips beats, or flutters.
- You are bleeding from the area where the catheter was put in your blood vessel.
- You have a fast-growing, painful lump at the catheter site.
- You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the catheter site.
- Pus draining from the catheter site.
- A fever.
- Your leg is painful, looks blue, or feels cold, numb, or tingly.
- You have new or worse trouble breathing.
Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.
How do you prepare for patent foramen ovale (PFO) closure?
Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.
Preparing for the procedure
- Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
- Understand exactly what procedure is planned, along with the risks, benefits, and other options.
- Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
- If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
- Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
How can you care for yourself after a patent foramen ovale (PFO) closure?
Activity
- Your doctor can let you know when you can return to regular activities. This may be in 1 or 2 days.
- Do not do strenuous exercise and do not lift, pull, or push anything heavy until your doctor says it is okay. This may be for at least 1 week.
- Try not to walk up stairs for the first couple of days. This will help the catheter site to heal.
- Rest when you feel tired.
Diet
- Eat heart-healthy foods. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit sodium, alcohol, and sugar.
- If your bowel movements are not regular right after the procedure, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.
Medicines
- Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
- Your doctor will likely prescribe a medicine that prevents blood clots. Be sure to get instructions about how to take your medicine safely. These medicines can cause serious bleeding problems.
- Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
Care of the catheter site
- For 1 or 2 days, keep a bandage over the spot where the catheter was inserted. The bandage probably will fall off in this time.
- Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your skin.
- You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry.
- Do not soak the catheter site until it is healed. Don't take a bath or swim for 1 week, or until your doctor tells you it is okay.
- Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.
- If you are bleeding, lie down and press on the area for 15 minutes to try to make it stop. If the bleeding doesn't stop, call your doctor or seek immediate medical care.
Other instructions
- Carry your device identification card with you at all times.
- For 6 months after having the PFO closure, be sure to tell all of your doctors and your dentist that you have the device in your heart. This is important because you may need to take antibiotics before certain procedures to prevent infection.
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