The Foramen Ovale is a flap like opening in the upper heart chambers (atria) which allows communication (eg. blood/blood clots (emboli)/air bubbles) to flow between the atria. It is present in all fetuses and closes shortly after birth. If it does not close, it is called Patent Foramen Ovale (PFO) through which blood clot can pass from right atrium to left atrium, resulting in stroke if the clots go to the brain. PFO can be closed by inserting a device through the blood vessels in the groin (percutaneous transcatheter approach).
Some of these complications, if they occur, are of a serious nature and may require further treatment including surgery and prolonged hospitalisation. In the event of device dislodgement, you may require surgery for removal of the device and closure of the PFO at the same time.
Some studies suggest that PFO may be present in as high as 27% of the population. It is diagnosed on transthoracic and transoesphageal echocardiography with demonstrable significant right to left shunting (evidence for blood going from right to left chambers).
However, not all PFOs need to be closed. The PFO device was approved in 2016 by the US Food and Drug Administration (FDA) based on 10 year resuts of a randomized study which involved patients <60 years old with PFO and cryptogenic stroke (of unknown cause). It compared patients treated with PFO device plus blood thinning medications with patients treated with blood thinning medications alone and found a 50 percent reduction in new strokes in patients with PFO device. Other less common indications for closure include decompression illness in professional divers, cyanosis (mixing of deoxygenated [blue] blood in the left chambers causing breathlessness especially with certain posture.
The patient will need to fast at least four to six hours prior to the procedure and certain medications held off.
The patient usually stays in hospital overnight after the procedure for observation before discharging home the next day after chest X-ray and echocardiography.
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