Patent foramen ovale (PFO) closure

A PFO closure is a structural heart disease treatment to close a small hole called a foramen ovale between the upper two heart chambers (atria). Everyone is born with this hole, which keeps blood from circulating to the lungs before a baby is born. Usually, this hole closes shortly after birth, when a baby’s lungs begin functioning.

A patent foramen ovale occurs when the hole doesn’t seal as it should. Most PFOs don’t need to be closed. Most PFOs cause no symptoms or complications. Larger PFOs may cause stroke. People with symptomatic or large PFOs may benefit from a procedure to close the hole.

Specialists in our Interventional Cardiology Program use a long, flexible tube (catheter) to insert a closure device in the hole. This device closes the PFO and prevents blood flow between the left and right atria.

Your care team will give you specific instructions for preparing for a PFO closure. You may need to stop taking certain medications, such as blood thinners, for a brief period before the procedure. You’ll need to stop eating or drinking around midnight on the day of the procedure.

You may have a few tests before the procedure to help your interventional cardiology team evaluate your heart, determine the size and shape of the PFO, and plan the procedure, such as:

• Echocardiogram to look at your heart’s anatomy and blood flow
• Electrocardiogram to check your heart rhythm

PFO closure takes about 30 minutes and is performed as an outpatient procedure. Your doctor will use conscious sedation, where you’re awake but receive medicine to keep you calm and comfortable.

During the procedure, an interventional cardiologist:

• Makes a tiny incision in your groin and inserts a catheter into a blood vessel
• Uses ultrasound imaging to get a closer view of the PFO
• May guide a deflated balloon through the catheter and move it to the PFO. They inflate the balloon to measure the size of the hole and help choose the appropriate-sized closure device
• Threads the closure device through the catheter and positions it in the hole
• Positions the closure device so that it attaches to each side of the PFO, effectively closing the hole

There are several PFO closure devices available, tailored to the size and anatomy of the hole. At Penn, we use all available PFO closure devices so we can customize treatment based on your needs.

Although most people with a PFO don’t experience symptoms, signs of a PFO can be serious, including stroke or transient ischemic attack (TIA). PFO closure eliminates these serious risks more effectively than blood-thinning medications. Compared to open-heart surgery, a catheter-based PFO closure offers a smaller incision and quicker recovery, including a shorter hospital stay.

PFO closure complications are very rare. When they occur, risks of PFO closure may include:

• Arrhythmias (irregular heart rhythms)
• Bleeding
• Blood vessel damage
• Infection
• Problems with the PFO closure device, such as the device moving out of place

The Penn interventional cardiology team has decades of experience in a wide range of structural heart disease treatments, including PFO closure. When you choose Penn, you benefit from:

• Deep expertise: Penn is one of the largest referral centers for PFO closure in the Philadelphia region, placing us among the highest-volume centers in the area. We care for patients with the most complex needs with leading-edge, research-based treatments.
• Personalized treatment options: Our interventional cardiologists use every available PFO closure device. This allows us to customize your treatment based on the size and shape of the hole in your heart, leading to better long-term results.
• Clinical trials: We’ve participated in every PFO closure clinical trial, starting more than 20 years ago. Our history of innovation and research continues today with our ability to offer promising new therapies through clinical trial treatments.