Patent Foramen Ovale (PFO) Closure

Overview
The heart is divided into four separate chambers. The upper chambers, or atria, are divided by a wall called the atrial septum.  

Patent Foramen Ovale (PFO)
The foramen ovale is a flap or tunnel shaped hole in the atrial septum during fetal development that allows blood to travel through the heart without going to the lungs. When in the womb, a baby does not use his or her own lungs, receiving oxygen rich blood from the the mother through the umbilical cord. Therefore, blood can travel from the right side of the baby's heart to the left side of the heart through the foramen ovale, skipping the trip to the baby’s lungs.

This small flap-like opening normally closes shortly after birth as the pressure from the baby’s heart pushes the flap to the septal wall. If this opening does not close shortly after birth, a Patent Foramen Ovale (PFO) results. This type of defect generally works like a flap valve, only opening during certain conditions when there is more pressure inside the chest. This increased pressure occurs when people strain while having a bowel movement, cough, or sneeze. If pressure is great enough, blood may travel from the right side of  the heart to the left side through the tunnel in the septal wall. If there is clot or particles present, it can travel with the heart crossing the septal wall and entering left atrium. This increases the risk of the clots travelling out of the heart to the brain causing stroke or to the coronary artery causing a heart attack. 

 
FIGURE 2: Patent Foramen Ovale (PFO)

Symptoms of PFO
PFO is the most common type of heart defect. In fact, one in four people may have a PFO to some degree, but in many cases it is not large enough to create symptoms or require any immediate treatment in childhood. Many people grow up and lead normal life without even knowing they have PFO. Patent Foramen Ovale is frequently not diagnosed until adulthood. However they are a number of harmful and life affecting conditions caused by PFO. It is suspected to be the cause of cryptogenic stroke.

Some common symptoms of stroke are:

•  weakness or numbness of the face, arm or leg on one side of the body
• loss of vision or dimming (like a curtain falling) in one or both eyes
• loss of speech, difficulty taking or understanding what others are saying
• sudden severe headache with no known cause
• loss of balance, unstable walking

Diagnosis of PFO
Patent Foramen Ovale can be detected by echocardiogram or a Transesophageal echo. In some cases the patient is asked to cough or Valsalva maneuver to increase the pressure in the right atrium. this can increase the flow of blood from left to right atrium.

Treatment  

Medical Management
People who do not have associated problems such as stroke or transient ischemic attack (TIA) do not need any treatment. However patients who present with the  above named symptoms may be placed on some types of blood thinner medications, such as aspirin, plavix or warfarin to prevent recurrent stroke.

Non-surgical Treatment
In some cases a cardiologists may recommend closure of PFO. In Mercy Angiography Unit cardiologists use implantable AMPLATZER PFO Occluder to close the defect.
AMPLATZER® PFO Occluders for heart defect repair utilise the shape memory of Nitinol, a wire made from an alloy of nickel and titanium. Each Occluder is made of a Nitinol wire mesh that is shaped into two flat discs and a middle, or “waist” to pull the discs up to the septum wall.  Polyester fabric inserts help close the hole and provide a foundation for growth of tissue over the occluder after placement.

AMPLATZER® PFO Occluders for heart defect repair utilise the shape memory of Nitinol, a wire made from an alloy of nickel and titanium. Each Occluder is made of a Nitinol wire mesh that is shaped into two flat discs and a middle, or “waist” to pull the discs up to the septum wall.  Polyester fabric inserts help close the hole and provide a foundation for growth of tissue over the occluder after placement.

The PFO procedure typically takes place in a special room called a catheterisation laboratory (cath lab) where many minimally invasive, non-surgical procedures are performed, most common one being coronary angiogram. The PFO Occluder is delivered through a catheter, a small plastic tube used to access the heart. The physician deploys the occluder to expand each disc on either side of the defect, closing off the hole.

After the Procedure
After recovering from anesthesia and with adequate bed rest, if there is no complications,upon discretion of the cardiologists, patients may go home that day or stay overnight in the hospital. Before leaving a chest x-ray and/or echocardiogram will be performed to make sure device is still positioned properly. prior to your discharge the cardiologists and/or the ward staff will give you guidelines or advice about resuming your normal daily activities.  

Video Demonstration

 PFO device deployment: Radiographic illustration
 The Amplatzer PFO Occluder
 PFO Occluder Placement

Associated Documents

 Pre-visit instructions for Patent Foramen Ovale (PFO) closures
 Amplatzer PFO Occluder: A Patient's Guide