A patent foramen ovale (PFO) is a small flap-like opening between the upper chambers of the heart that fails to close after birth. It is present in around one in four people and is usually harmless. In selected patients, however, a PFO can allow a small clot to pass from the venous circulation to the arterial circulation and cause an embolic stroke.
When closure is considered
PFO closure may be discussed for:
- Cryptogenic stroke (stroke without an identified cause) in adults under 60, where workup suggests the PFO is the likely mechanism
- Selected patients with recurrent stroke despite medical therapy
- A small group of patients with platypnoea-orthodeoxia syndrome
PFO closure is not appropriate for everyone with a PFO. The decision involves a stroke specialist and a cardiologist working together, often using a structured scoring system (such as the RoPE score) to estimate the likelihood that the PFO contributed to the stroke.
The procedure
Closure is performed in the cardiac catheterisation laboratory, usually under conscious sedation, through a vein in the groin. A device is delivered across the PFO and deployed to close the opening. The procedure typically takes around 45 to 60 minutes and most patients go home the next day.
Risks
Risks include vascular access complications, atrial arrhythmia (most commonly atrial fibrillation in the first weeks), device embolisation (very rare), and pericardial effusion. Antiplatelet therapy is required for a defined period after closure.