PFO Closure

Overview

A PFO is is a connection between the left and right collecting chambers which usually closes at birth.

It is a remnant of the fetal circulation when it’s purpose is to provide a bypass for the lungs as they are not used in the womb. About 25% of the general population have a PFO. Closure of a PFO is indicated in limited situations and can be carried out using catheters and small umbrella like devices. There is a 95% chance of successful closure.

Different devices for hole closure.

Do I need PFO closure?

The government’s NICE guidelines publish recommendations for doctors regarding who should have a PFO closed. It is common to consider closure of PFO in divers with recurrent paradoxical emboli (decompression illness, or “the bends”) and in young patients who have suffered a stroke. Much was made of a connection between PFO and migraine but more research is needed to clarify this link. Migraine is not yet a definite indication for PFO closure.

What is involved and what are the risks?

On the day you will be given either a general or local anaesthetic. A pipe is passed from a needle puncture in the leg to the heart. The operation is guided by X-rays from the outside, and by ultrasound pictures from a probe in your throat or your leg.  This guides a wire which is passed across the hole in the heart. A stiff tube is passed over the wire and an umbrella device is placed across the hole through this pipe.  The pipes are taken out and the hole in the leg (where the pipes have been) is pressed on to stop the bleeding.

Your blood is thinned during the procedure. Therefore there can be bleeding problems from the leg and also internally. Sometimes blood leaks into the bag surrounding the heart and a further procedure is needed to help release it. Very rarely emergency surgery is required. The complications include: rhythm problems – these usually settles with medication; device detachment- if the umbrella moves, then it has to be recaptured. If it cannot be recaptured, then surgery may be needed to remove it ; stroke- if a small clot form on the device or any of the pipes and moves to the brain.

The overall complication rate is about 2% after the procedure. Death is very rare.

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