What is a PFO? Everything you need to know about heart hole closure

Have you ever heard a doctor say that someone has a "hole in the heart"? You might have even heard this term used for your own health. Actually, all of us have a tiny opening in our hearts while growing inside our mother's womb. This opening is very important during that early stage of life. But after a baby is born, this small hole usually closes on its own.

However, in some people, this hole does not close completely. Doctors call this medical condition a Patent Foramen Ovale, or PFO for short. This happens in about one out of every four people. Many people live with a PFO and never experience any health problems at all. Even so, this small opening can sometimes cause serious medical complications for certain people. When that happens, doctors may discuss a procedure known as PFO closure.

Simply Put, What is PFO Closure?

PFO closure is a procedure used to permanently seal the small hole located between the two upper chambers of your heart. Instead of making a large surgical cut on your chest, your doctor uses a different approach. They thread a very thin, flexible tube called a catheter through a large blood vessel in another part of your body up to your heart.

Through this tube, the doctor guides a special tiny medical device into the heart hole to close it up. Think of this device as a tiny double-sided button or a small toy yo-yo. One side of the device covers the front of the hole. This the other side covers the back.

However, if your PFO is very large, measuring more than 25 millimeters, your doctor might choose open heart surgery instead of using a catheter. Thankfully, those complex situations are quite rare.

When is This Treatment Needed?

Many people have a PFO and never need any medical treatment. But in certain situations, doctors recommend closing the hole. This happens most often if the hole allows tiny blood clots to travel to the brain and cause problems.

How to Prepare for the Treatment

Before you undergo this procedure, your medical team will perform several diagnostic tests to check your heart health thoroughly.

• A chest X-ray to view your heart and lungs.
• An echocardiogram to create moving pictures of your heart structure.
• An electrocardiogram (ECG) to measure the electrical activity of your heart.
• Routine blood tests to check your overall health.

Also, your doctor will ask you to start taking medicines like Aspirin and Clopidogrel to help prevent blood clots. Your doctor will give you exact instructions on when to start these medicines. You will also receive medicine during the procedure to stop your blood from clotting too quickly.

Step-by-Step Procedure

This procedure usually takes about one to two hours to complete. Here is what happens during the process:

1. Numbing the Area: First, the medical team applies a local numbing medicine to the skin near your groin where the catheter enters. In some cases, doctors may use general anesthesia so you sleep through the procedure.

2. Making a Small Cut: The doctor makes a tiny incision in your groin area to reach the blood vessel safely.

3. Inserting the Catheter: The doctor gently guides the thin catheter into a large blood vessel through this small cut.

4. Reaching the Heart: The medical team carefully guides the catheter up through your blood vessels until it reaches your heart.

5. Taking Pictures: The doctor injects a special dye and takes X-ray pictures, known as an angiography, to see your heart clearly. They also use an ultrasound scan inside the heart to measure the exact size of the PFO.

6. Measuring the Hole: A catheter with a tiny balloon at the tip is inflated inside the hole to measure its exact dimensions.

7. Placing the Device: The doctor passes the PFO closure device through the catheter and positions it carefully so it snaps open on both sides of the hole.

8. Checking the Position: The medical team uses an imaging scan called a transthoracic echocardiogram to confirm the device sits securely in the right spot.

9. Finishing Up: Once everything looks correct and secure, the doctor removes the catheter and closes the skin opening.

What Happens After the Treatment?

After the procedure, you must rest flat on your back for about six hours. In most cases, you can go home later that same day or by the following morning. Once you return home, you should follow these important recovery guidelines:

• You can walk around gently, but avoid fast walking or running.
• Do not drive any motor vehicles for at least two days.
• Do not lift anything heavier than 10 pounds (about 4.5 kilograms) for one week.
• Avoid heavy exercise and strenuous physical activities for a full month.
• Most people return to their normal daily routines within one week. However, always talk with your doctor and follow their specific personal instructions.

Your doctor will prescribe medicines for you to take at home. You will need to take Aspirin or other blood-thinning medicine every day for at least six months. For certain dental or medical procedures, your doctor may also ask you to take an antibiotic first. Your doctor will explain all of these instructions clearly before you leave the hospital.

Benefits and Risks

Benefits

• Lowers the future risk of having another unexplained stroke.
• The internal heart device remains completely invisible and unnoticeable to you.
• Leaves no large surgical scars on your body.
• Long-term studies prove that the materials used in the closure device are very safe.

Risks

This procedure is very safe when performed by an experienced heart specialist. However, just like any medical procedure, small risks do exist.

• Temporary abnormal heart rhythms, such as atrial fibrillation.
• The formation of new blood clots.
• Bleeding or infection at the site where the catheter entered your body.
• Very rarely, the closure device can move slightly from its original position.
• Adults over the age of 60 may have a slightly higher chance of minor complications.