Patent foramen ovale
Opening of the patent foramen ovale with passage of blood from the right atrium to the left atrium.
Double disc device for closing PFO
PFO device, composed of a flexible metal alloy (Nickel and Titanium).
PFO closure with a double disc device
PFO closure device is used to close the PFO.
Why are you being offered a closure of the PFO?
The foramen ovale is a passage in the septum separating the two atria of the heart present at the embryonic stage of life and which closes spontaneously shortly after birth. It may happen that this closure does not occur or reopens (this is called a "patent" foramen ovale) and is responsible for symptoms in adulthood, the most serious of which is stroke, a neurological complication requiring closure of the PFO to prevent a recurrence.
Performing the closing gesture:
Your test will take place in the interventional cardiology unit.
When you are admitted to the cardiology department, you will be asked to put on a hospital gown. You will need to remove all jewelry, underwear and socks.
A small area of your groin will be shaved which will be the entrance route for the examination.
A stretcher-bearer will take you to the catheterization room in your bed. You will be helped onto a narrow, hard table. It will be a little cold in the room. Around you, you will see X-ray machines and monitors. Small sticky patches will be placed on your chest. These will be connected to a heart monitoring machine. Your body will be covered with a large sterile drape. General anesthesia will begin.
The procedure involves implanting a device comprising two metal mesh discs connected by a small connector and positioned on either side of the septum between the two atria to make it watertight. This flexible device is implanted by cardiac catheterization via a puncture of the femoral vein.
This procedure is performed with ultrasound guidance (usually via transthoracic or transesophageal route), requiring general anesthesia or simple sedation.
In more than 80% of cases, communication between the two atria disappears completely just after the implantation of the device. In other cases, the closure will be effective in the following weeks.
You will be asked to lie down for a few hours after the procedure.
You will generally be discharged the day after the procedure after a transthoracic ultrasound scan.
Can I eat and drink before this test?
You must be more than 12 hours before the exam. We try to respect the order and time of passage according to the organization of the day. However, depending on the emergencies of the day, the duration of the interventions of the day, it is possible to have a waiting time of several hours.
What are the expected benefits?
In large-scale studies, PFO closure combined with antiplatelet therapy reduces the risk of recurrent stroke by approximately 60% compared with antiplatelet therapy alone (most commonly low-dose aspirin).
What are the risks involved?
Despite the experience of the operators and the significant technical progress concerning catheters and devices, this is an invasive procedure involving risks:
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Allergic complications most often linked to the use of anesthesia products.
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Vascular complications at the femoral puncture site: the most common is a hematoma which results in a bluish appearance usually without consequence and disappearing after a few days. Rarely (<1% of cases), a vascular injury may require surgical repair or transfusion.
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Cardiovascular complications during the hospital period: they are very rare (<0.5% of cases) of stroke, hemorrhagic effusion around the heart or displacement of the device, which may require additional intervention, sometimes surgical.
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Cardiac complications after hospital discharge: the most common complication is the occurrence of palpitations linked to a rhythm disorder (<5% of cases): generally early (first weeks) and transient, this arrhythmia may require an action or additional treatment if it persists. Much more rarely (<0.5% of cases), the formation of clots on the device or a displacement of the device may occur.
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Complications leading to death : these are very exceptional (<0.1%).
What follow-up after the device implantation?
The implantation of the device requires taking antiplatelet treatment for a minimum period of 6 months, which is generally continued at a lower dose in the long term.
No special physical or professional precautions are necessary after implantation of the device. This device also does not contraindicate any future exploration or intervention.
Antibacterial prophylaxis will be offered in the event of risky extracardiac procedures during the 6 months following implantation of the device.
An ultrasound follow-up will be offered between 6 and 12 months to ensure the absence of significant residual communication between the 2 atria.
Patent foramen ovale closure
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