PFO Closure

What Is a PFO Closure?

A patent foramen ovale (abbreviated PFO) is a heart defect that manifests through a permanent flap-shaped hole between the left and right atrium. During fetal development, this small opening in the cardiac septum has an essential function in which oxygen-rich blood from the maternal circulation can bypass the still non-functional lungs and enter the fetal circulation to supply the fetus with oxygen. Usually, a reduced pulmonary circulation resistance leads to spontaneous closure of the foramen ovale a few days to weeks after birth, thereby strictly separating the right and left sides of the heart. In the case of absent closure, it is named PFO. Especially strokes without a clear cause are often associated with a PFO, since blood clots, for example, can travel from the deep veins of the legs through the PFO into the left atrium and from there via the left ventricle into the body's circulation, where they can block cerebral arteries. 
One possible therapy is the so-called PFO closure. The PFO is closed by an interventional procedure to prevent blood flow between the left and right atrium, avoiding blood clots from reaching the brain supplying arteries and, which could otherwise, in the worst case, lead to a stroke.

For Whom Is a PFO Closure Surgery Suitable?

Up to 25% of the population lives with a PFO, and although many of these patients are symptom-free, it can come to a significant health risk to other patients. 
Recent studies show that PFO closure is promising for individual patients, but is not recommended for all patients. Whether an existing PFO should be closed depends on several criteria and must be discussed and decided with a specialist. An important indication is if the patient has already suffered a first stroke without an identifiable cause and has an atrial septal aneurysm, i.e., a balloon-like dilatation of the atrial septum. Age also plays a role; a PFO closure is an option, especially for younger patients.

Available Methods

Although PFO closure can be carried out surgically with open access to the heart, the interventional method using a cardiac catheter is now considered the gold standard. This procedure usually does not require general anesthesia; the risk of complications is low, and the patient recovers quickly and can leave the hospital after a few days.

Procedure and Duration

Interventional PFO closure is carried out minimally invasive, which means that a vessel in the groin is punctured, and a catheter is forwarded to the region of the heart defect. Since the patient is locally anesthetized and often put into half-sleep, i.e., slight sedation, pain is not felt. 
The procedure aims to place a disc catheter, also known as a PFO occluder, on the atrial septum and then unfold it, so it anchors to the PFO from both sides and completely closes the defect. Transesophageal echocardiography is carried out at the same time to closely monitor the position of the catheter and fit of the occluder.
 The duration of the procedure is usually 1 to 2 hours.

Possible Complications and Aftercare

Although the risk of complications after PFO closure is generally low, they cannot be excluded entirely, as with all procedures.

In the rare case of misplacement, there is a risk of dislocation or detachment of the disc, which can impede arterial circulation in rare cases. Typically a dislocation is prevented by optimal placement, so the disc will grow together with the surrounding tissue after four weeks and fit securely so it will not loosen.

So-called air embolism will rarely occur, i.e., the unintentional entry of air into the bloodstream associated air bubbles that can clog vessels, which can be largely avoided by careful and controlled procedures.
 After the process, groin examination and transthoracic echocardiography ensure that the patient is free of complications and usually allows leaving the hospital after 1-3 days.

Patients should take blood-thinning medication after consultation with their treating physician until the outpatient follow-up takes place. The correct position of the disc is checked by transesophageal echocardiography after six months. The blood thinners can be discontinued if it fits well.
 Furthermore, endocarditis prophylaxis should be taken into account, especially in the case of dental treatments.

Which Doctors and Centers Are Specialized in PFO Closure?

Specialists in interventional PFO closure are cardiologists and cardiac surgeons who specialize in heart surgery.

Prof. Horst Sievert, MD, is a specialist in cardiology and angiology and head of the CardioVascular Center (CVC) in Frankfurt am Main. Through its team of experts from various fields, the CVC offers treatment options at the highest level, especially in cardiac catheters. The CVC, lead by Prof. Horst Sievert, MD, is a leading international center for interventional cardiology and angiology, treating patients from all over the world.

Prof. Hüseyin Ince, MD ist Facharzt für Kardiologe und leitet das Department Kardiologie am Vivantes Klinikum Berlin, ein deutschlandweit führendes Zentrum für Kardiologie.
Besonders im Bereich der interventionellen Medizin ist er führender Spezialist und bietet mit 7 Herzkatheterlaboren das hierfür größte Zentrum Berlins. Prof. Ince kann auf langjährige Erfahrung zurückgreifen und ermöglicht Ihnen modernste Medizin auf höchstem Niveau.

Prof. Hüseyin Ince, MD, is a specialist in cardiology and head of the Department of Cardiology at the Vivantes Klinikum Berlin, a leading center for cardiology in Germany.
 He is a leading specialist, especially in interventional medicine, and offers the largest Berlin center with seven cardiac catheter laboratories. Prof. Ince has many years of experience and enables you to benefit from the most modern medicine at the highest standard.

Prof. Roberto Corti, MD from the Department of Cardiology Zurich, has many years of experience in heart surgery and offers you state-of-the-art medicine and outstanding patient care. The Hirslanden Heart Clinic is the leading center for invasive surgery in Switzerland. It can rely on state-of-the-art technology combined with an innovative interdisciplinary network of experts to ensure patients receive the best possible treatment.

Sources:

1. Kardiologie compact, 2. Unveränderte Auflage, Thieme Verlag
2. www.dgn.org/presse/pressemitteilungen/2517-neue-studien-verschluss-eines-offenen-foramen-ovale-am-herzen-keine-standardtherapie