Have you ever heard of a "hole in the heart"? Maybe your own doctor has told you about it. In fact, we all have a small hole like this in our hearts when we are in the womb. It is a necessary thing at that time. But after birth, this hole usually closes on its own. But in some people, this hole remains without closing completely. We medically call this Patent Foramen Ovale, or `(PFO)` for short. This is a common condition that only about one in four people have. For most people, this does not cause any problems. However, for some people, it can cause complications. That is when we talk about the treatment `(PFO Closure)`.
Simply put, what is PFO Closure?
PFO Closure is a minor surgery to permanently close the small hole (PFO) between the two upper chambers (atria) of your heart. However, it doesn't require a large incision. The doctor inserts a very thin, flexible tube, called a ``catheter'', into your heart through a large blood vessel elsewhere in your body.
Through this tube, a small, specially designed device is inserted into the hole in the heart and closed. Think of this device as a little yo-yo, or a little button with two circles on either side. One circle covers one side of the hole, and the other circle covers the other side.
Within a few days of the device being inserted, your body's own tissue begins to grow around it. After about three to six months, the device is completely covered by heart tissue, becoming part of the heart wall.
However, suppose your PFO is larger than 25 millimeters. In that case, your doctor may decide to perform open surgery instead of this `(Catheter)` method. However, such cases are very rare.
In what cases is this treatment necessary?
Most people with a PFO do not need any treatment. However, in some cases, especially if a blood clot can travel through the hole to the brain and cause problems, a doctor may recommend this treatment.
| When PFO Closure Treatment May Be Recommended | |
|---|---|
| Cryptogenic Stroke | Especially if a young person has had multiple strokes like this. |
| Transient Ischemic Attack (TIA) | This is like a mini-stroke. If this happens again and again. |
| Decreased oxygen levels in the blood | In some cases, PFO can cause low oxygen levels in the blood. |
| Migraines | There is evidence that PFO is linked to some severe migraine conditions. |
| A blood clot travels | If a blood clot has traveled through the PFO and traveled to another part of the body. |
How do you prepare before treatment?
You will need to undergo several tests before this treatment.
- Chest X-ray
- A heart scan (Echocardiogram)
- ECG test (Electrocardiogram)
- Several blood tests
In addition, you will be told to start taking medications such as aspirin and clopidogrel to prevent blood clots. Your doctor will tell you the exact day you should start taking these medications. During treatment, you will also be given other medications to prevent blood clots.
How the treatment works step by step
This treatment usually takes about an hour or two. Here's what happens when it's done:
1. Numbness: First, a local anesthetic is given to numb the area in the groin where the catheter will be inserted. Sometimes, general anesthesia may be used if necessary.
2. Small incision: A very small incision is made in the groin area.
3. Inserting the catheter: The catheter is inserted into a large blood vessel through the incision.
4. Moving to the heart: Then, the catheter is very carefully moved to the heart.
5. Imaging: A special dye is injected into the heart to take a closer look and X-ray images are taken (Angiography). Also, a scan of the inside of the heart (Ultrasound) is used to measure the exact size of the PFO.
6. Measuring the hole: A catheter with a special balloon is inserted, inflated, and the exact size of the hole is measured.
7. Insertion of the device: Now the PFO closure device is passed through the catheter into the heart and secured to the sides to close the hole.
8. Confirming the location: Another scan (Transthoracic Echocardiogram) is performed to check if the device is in place.
9. Completion: If everything is OK, the catheter is carefully removed.
What happens after treatment?
After the treatment, you will need to rest in bed for about 6 hours. You will probably be able to go home the same evening or the next morning. Here are some things to keep in mind after you go home:
- You can walk, but don't walk fast.
- Don't drive for two days.
- Do not lift more than 10 pounds (about 4.5 kg) for a week.
- Do not do any strenuous exercise for a month.
- You can usually return to your normal activities within a week. However , it is important to discuss all of this with your doctor and follow his or her instructions.
You will be prescribed medication to use at home. You will need to take aspirin or other blood thinners every day for 6 months or more. You will be told to take antibiotics before certain medical procedures, such as dental cleanings. Your doctor will explain all of this to you.
What are the benefits and risks of this?
Benefits
- It can prevent future strokes for which no cause can be found.
- You won't feel this device on your body.
- It won't leave a big scar.
- The materials from which this device is made have long been proven to be very safe.
Risks
This treatment is very safe when performed by an experienced doctor, but as with any medical procedure, there are some risks.
- Abnormal heartbeat (Atrial Fibrillation).
- Blood clots.
- Bleeding or infection at the catheter site.
- The device moves from its place of installation (this happens very rarely).
- People over the age of 60 are slightly more likely to develop complications.
If you experience any unusual symptoms, such as swelling, excessive pain, bleeding, or fever at the catheter site, you should notify your doctor immediately .
Take-Home Message
- A PFO is a small hole in the heart that most people have and is usually harmless.
- This PFO Closure treatment is only done to prevent specific risk conditions such as stroke.
- This is a safe treatment method that does not require a large incision and is usually done through a catheter.
- After treatment, it is very important to take the medication prescribed by the doctor on time, in the prescribed manner, and to follow his instructions.
- Before deciding whether this treatment is right for you, talk to your doctor carefully, understand the pros and cons, and make a decision that you both agree on.
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