Patent Foramen Ovale (PFO) Closure

A patent foramen ovale (PFO) is a hole in the wall that divides the upper left and upper right chambers of your heart. During PFO closure, your doctor will use a small, thin tube called a catheter to implant a closure device that plugs your PFO.

UPMC structural heart experts perform the most advanced minimally invasive surgery for patients who need a PFO closure.

What Is PFO Closure?

A patent foramen ovale (PFO) is a hole in the wall that divides your heart's upper left and upper right chambers. Everyone has this opening before birth, but it should grow closed at birth or shortly thereafter. However, in some people, the hole remains open.

During PFO closure, your doctor will implant a closure device that plugs your PFO using a catheter that is threaded through a vein in your groin and guided to your heart. Your doctor will guide the device using the imaging assistance of an electrocardiogram.

Conditions we treat with PFO closure

• Patent foramen ovale (PFO).

Why Would I Need PFO Closure?

You may need a PFO closure procedure if your PFO remains open. Many cases of PFO do not cause any symptoms and do not have to be treated. However, in some cases, blood clots in the heart may move through the PFO, travel to the brain, and cause a stroke.

A PFO can also cause a significant amount of blood to bypass the lungs, resulting in low blood oxygen levels, which is called hypoxia. This usually happens when other conditions are present, such as congenital or valvular heart disease or pulmonary hypertension.

Who’s a candidate for PFO closure?

You may be a candidate for PFO closure if your PFO is causing complications such as stroke or hypoxia. You may also be a candidate for PFO closure if you are at high risk of stroke or other complications in the future.

What Are the Risks and Complications of PFO Closure?

Although PFO closure carries a low risk of complications, as with any surgery, there are some risks, including:

• Stroke.
• Damage to the artery used for insertion of the PFO closure device.
• Abnormal heart rhythms or need for a pacemaker.
• Major bleeding.
• Infection.
• Problems with the PFO closure device.
• Other serious life-threatening events or even death.

Is it worth closing a PFO?

The decision to close a PFO is complex. At UPMC, our multidisciplinary team of cardiac surgeons, interventional cardiologists, structural heart experts, and vascular surgeons work together to assess each patient’s individual risk for stroke and other complications. Your cardiology team will recommend whether your PFO should be closed based on your individual risk factors, overall health, and personal preferences.

What Should I Expect From PFO Closure?

Before: How to prepare for PFO closure

Your doctor will explain the PFO closure procedure to you and answer your questions. To prepare for the procedure, you should:

• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have heart valve disease. You may need to receive an antibiotic before the procedure.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. You may need to stop some of the medications prior to the procedure.
• Fast for a certain time before the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home. 

Your doctor will let you know if you can leave the hospital the same day as your procedure or if you will need to stay overnight. If you will be staying overnight, you should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.

How long does PFO closure take?

PFO closure takes between 30 minutes and two hours.

During your PFO closure

The PFO closure procedure is relatively painless and requires no surgical incisions. You will receive local anesthesia or a light sedative. You will be awake but should not feel any discomfort during the procedure.

During PFO closure, your doctor will implant a closure device that plugs your PFO using a catheter that is threaded through a vein in your groin and guided to your heart. Your doctor will guide the device using the imaging assistance of an echocardiogram.

Recovery after PFO closure

After a PFO closure, you may be able to leave the hospital the same day or after an overnight stay. Before you leave the hospital, a chest x-ray and/or echocardiogram will be performed to ensure your PFO closure device is properly positioned.

How long is recovery from PFO closure?

After a PFO closure procedure, most people have minimal restrictions on normal physical activity and are back to their normal routines within a week. You should talk to your doctor about when you can drive and return to work.

When to call your doctor about PFO closure complications

You should call your doctor if you are experiencing any unusual symptoms, including:

• Pain, redness, bleeding, drainage, or increased swelling at the insertion site.
• Trouble walking or speaking.
• Numbness on one side of your body.
• Severe pain, coldness, numbness, or discoloration in the limb where the catheter was inserted.
• A fever of more than 100.0°F.

If any of these symptoms are severe, you should dial 911 immediately.

What’s the prognosis after PFO closure?

PFO closure is an effective procedure for reducing stroke risk and preventing PFO-related complications. However, you may need ongoing follow-up care to manage your stroke risk factors and ensure that your PFO closure device stays in place.

What’s the success rate of PFO closure?

PFO closure is more than 90 percent effective. However, you may need long-term monitoring to ensure your device stays in place. You may also need to take medication to reduce your stroke risk.

Why Choose UPMC for PFO Closure?

At UPMC, our experts are at the forefront of minimally invasive cardiovascular surgery. The minimally invasive PFO closure procedure may eliminate the need for open-heart surgery in certain patients. The procedure may also prevent the need for PFO patients to be on lifelong drug therapy to prevent strokes.

By UPMC Editorial Staff. Last reviewed on 2024-10-01.