What is Patent Foramen Ovale Closure (PFO)

Patent foramen ovale is a hole between the upper chambers (right atrium and left atrium) of the heart. A patent foramen ovale closure is a surgical procedure to close this hole by placing a closure device inside the hole.

The most common type of surgery for patent foramen ovale closure is cardiac catheterization. This involves inserting a long, thin tube (catheter) into a vein and threading it to the heart.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Stroke.
• Allergic reactions to medicines, dyes, or the closure device.
• Damage to other structures or organs.
• The closure device moving out of position in the heart.
• Irregular heartbeat.
• A heartbeat that is too slow (heart block, or bradycardia).

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines before and after the procedure. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You may need blood tests.
• You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV will be inserted into one of your veins.
• You may be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area for the procedure (local anesthetic).
• Sticky patches (electrodes) will be placed on your chest. The electrodes will be connected through wires to an electrocardiogram (ECG) monitor. The ECG will record the electrical activity of your heart during the procedure.
• A small incision or puncture will be made in your inner thigh or groin area.
• A catheter will be inserted into a vein in your inner thigh or groin area. The catheter will be moved up to your heart.
• Contrast dye may be injected into your heart, and then X-rays of your heart may be taken to help position the closure device. Dye helps to make your heart structures show up on X-rays.
• A closure device will be passed through the catheter and inserted to close the hole in your heart.
• The catheter will be removed.
• Pressure will be placed on the vein in your inner thigh or groin area to prevent bleeding.
• The vein where the catheter was inserted may be closed with stitches (sutures).
• A bandage (dressing) will be placed over the inner thigh or groin site.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will need to stay in the hospital after the procedure. Ask your health care provider how long you will stay.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You will have an imaging test to check the closure device, such as a chest X-ray, ECG, or echocardiogram.
• You may have some pain. You will be given pain medicine as needed.
• Do not drive until your health care provider approves.

Summary

• A patent foramen ovale closure is a procedure to close a hole between the upper chambers (right atrium and left atrium) of the heart.
• The most common type of surgery for patent foramen ovale closure is cardiac catheterization. This involves inserting a long, thin tube (catheter) into a vein and threading it to the heart so a closure device can be placed in the opening.
• You will need to stay in the hospital after a patent foramen ovale closure. Ask your health care provider how long you will stay.

Care After Patent Foramen Ovale Closure

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Bruising.
• Tenderness in the area where the long, thin tube was inserted into your inner thigh or groin area (catheter insertion site).

Follow these instructions at home:

Catheter insertion site care

• Follow instructions from your health care provider about how to take care of your incision or puncture. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your catheter insertion site every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
  • A lump or bump.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not drive until your health care provider approves.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• You may need to take medicines to prevent blood clots for 6 months or longer. You may have to take aspirin and clopidogrel. Clopidogrel is a blood thinner (anticoagulant) that helps to prevent heart attacks and strokes.

Lifestyle

• Avoid drinking alcohol.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

General instructions

• Drink enough fluid to keep your urine clear or pale yellow. This helps to get rid of the dye that was used during the procedure.
• Tell all health care providers and dental care providers who care for you that you had a patent foramen ovale closure. Do this before having any type of test or surgery.
• Ask your health care provider if you need to take antibiotic medicine before dental procedures and surgeries. This may be necessary to prevent infection.
• While taking anticoagulants:
  • Prevent falls by removing loose rugs and extension cords from areas where you walk.
  • Be very careful when using knives, scissors, or other sharp objects.
  • Do not play contact sports or participate in other activities that have a high risk of injury.
• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have pain that does not get better with medicine.
• You have fluid or blood coming from your catheter insertion site.
• You have a hard lump or bump at your catheter insertion site.

Get help right away if:

• You have trouble breathing.
• You have chest pain.
• You have redness, swelling, or pain around your catheter insertion site.
• Your catheter insertion site feels warm to the touch.
• You have pus or a bad smell coming from your catheter insertion site.
• You have severe pain in your arm or jaw.

Summary

• After the procedure, it is common for you to have some bruising and tenderness where a tube was inserted into your inner thigh or groin area (catheter insertion site).
• Check your catheter insertion site every day for signs of infection, such as redness, swelling, or pain.
• Before any procedure or test, tell all health care providers and dental providers who care for you that you had a patent foramen ovale closure.