Patent Foramen Ovale

We offer transcatheter closure of the patent foramne ovale (PFO). PFOs are small communications between the upper chambers of the heart in the atrial septum. This is a natural communication in a fetus and typically closes in the first few weeks of life. When the foramen ovale does not close it is called “patent”.  Patients are unaware that they have a PFO as it generally does not cause any problems.  The prevalence rate of PFOs in the general population is between 10-25%.  Of people who have a cryptogenic stroke - a stroke when no clear cause is found despite routine testing-- 50% have a PFO.  PFOs are felt to cause cryptogenic strokes and transient ischemic attacks (TIAs) by allowing blood clots to pass through the PFO and enter the brain rather than get cleared in the lungs as most clots are. In the past, closing these holes required open-heart surgery. We now close these defects in a day surgery procedure called a heart catheterization using the CardioSeal Septal Occluder or one of the Amplatzer family of occluder devices.  The procedure is usually performed under light sedation with intracardiac ultrasound guidance. It typically takes less than two hours and the patient is discharged home the same day.

On going trials in the United States are studying whether device closure (CardioSEAL or Amplatzer) is superior to medical therapy (Aspirin, Plavix, Coumadin or other blood thinners) to prevent recurrent strokes and TIAs.  Preliminary data suggests a significant reduction in recurrent events after device closure in the PFO population with an atrial septal aneurysm (3% of all PFOs) but data is unclear on the rate of reduction for "garden variety" PFOs.

The latest study started (M.I.S.T.) is studying if PFO closure can minimize migraines in patients with frequent recurrent migraines who have failed preventative medications. In summery, PFOs are common in the general population and ongoing research is being performed to determine if device closure reduces recurrent events as compared to treatment with medical therapy alone.  To determine if you are a candidate for PFO closure, you can schedule a consultation with Dr. Carl Garabedian. He has performed over 200 of these procedures in the last five year and can help you determine your options.