Dr Simon Kennon MB ChB, FRCP, MD Consultant Cardiologist

PFO/ASD Closure

PFO or ASD closure is a procedure to repair a small opening in the wall between the upper chambers of your heart. There are two kinds of openings: a patent foramen ovale (PFO) and an atrial septal defect (ASD).

The treatment

The techniques for PFO and ASD closure are almost the same; the procedure is performed using X-rays and echo ultrasound guidance, usually under a general anaesthetic.

Electrodes (small, sticky patches) will be placed on your chest. These are attached to a monitor to measure your heart’s electrical activity. Your heart will also be monitored with an echocardiogram (heart ultrasound), sometimes by passing a probe down your esophagus, or from your blood vessel into your heart.

A fine tube, a catheter, is passed from the blood vessel at the top of the leg to the heart, where it is guided across the PFO or ASD. A device, of which there are now many types, is carefully positioned to straddle the hole, and it is then deployed across the PFO/ASD. This will immediately diminish the potential for blood to shunt across the hole, and over time the body forms a thin lining over the device, reducing the shunt even further and generally sealing it completely.

Recovery

Patients can expect to go home either the evening of the procedure or the following day and is usually prescribed aspirin and similar drugs for a few months afterwards. You may feel sore from several hours of lying flat but this will go away in a day or so. The catheter site will be bruised, but this should go away in about a week. You might also temporarily have a sore throat if a tube was placed down your throat to take ultrasound images of your heart.

Patients can lead an entirely normal life after the procedure but should have intermittent reviews for life to check that all remains well.

Risks

There are risks with any kind of procedure, including ASD or PFO closure. But serious complications are rare. Risks include:

  • Temporary leg numbness or weakness in the first few hours afterward (rare)Bruising, bleeding, infection, or blood vessel damage where catheter(s) were inserted
  • Damage to the heart muscle that may require open heart surgery
  • Abnormal heart rhythm
  • Blood clots
  • Heart attack or stroke
  • Negative reaction to anesthetic or dye
  • Unforeseen complications