PFO Closure
Percutaneous Patent Foramen Ovale Closure
Percutaneous Patent Foramen Ovale Closure
Cardiac Catheter Treatment to Prevent Stroke
What is Percutaneous Patent Foramen Ovale Closure?
—Diagnosed with Stroke at a Young Age but the Cause is Unknown?—
A stroke with an unknown cause is called cryptogenic stroke. Among these cryptogenic strokes, there are cases where (although strictly speaking, the cause is unknown) it is thought to be related to a “patent foramen ovale”.
A patent foramen ovale is a small hole in the heart. This hole is present in everyone before birth, but it closes in most people after birth. It is reported that about 1 in 4 adults still have this hole open (patent foramen ovale). In young people, this patent foramen ovale has been reported to be a cause of stroke. The mechanism is thought to be that small blood clots formed in the veins of the lower limbs pass through the patent foramen ovale and enter the arterial system, causing embolic events such as stroke.
The “patent foramen ovale closure” is a treatment that prevents the recurrence of stroke by closing this hole in the heart with a closure device, preventing blood clots from passing through the blood flow. This treatment is performed using a catheter under general anesthesia, but the incision is small, and patients can walk from the day after the procedure. This percutaneous patent foramen ovale closure is a treatment to prevent the “recurrence” of stroke in people who have had a stroke before (only secondary prevention is possible).
Process of Percutaneous Patent Foramen Ovale Closure
To confirm the diagnosis of patent foramen ovale in the outpatient clinic, additional tests such as transesophageal echocardiography or contrast transthoracic echocardiography with intravenous injection may be performed. Usually, patients are admitted the day before the procedure. After general anesthesia, a sheath (plastic tube) is inserted into the femoral vein in the groin for inserting and removing the catheter. A guidewire is advanced through this tube to the atrial septum that separates the right and left atria, and passed through the patent foramen ovale. A guide catheter about 4mm in diameter is inserted from the right atrium to the left atrium along the guidewire. Through the guide catheter, the closure device is carried to the left atrium and placed to close the foramen ovale. The catheter is removed, and the treatment is completed. Patients can walk from the next day. After confirming the post-operative condition, patients are discharged the day after next (usual hospital stay: 3 nights and 4 days).
Benefits of Percutaneous Patent Foramen Ovale Closure
It has been reported that undergoing percutaneous patent foramen ovale closure and continuing antithrombotic drugs as needed results in a lower recurrence rate of stroke after about 3-6 years compared to continuing only antithrombotic drug treatment without closing the foramen ovale. As this is a preventive treatment, it may be difficult to feel the effect, but the future recurrence rate of stroke should be lower after treatment. In principle, antiplatelet medication is continued after treatment, but in some cases, it may be discontinued after about 6 months to 1 year of treatment in consultation with a neurology specialist.
Who is a Suitable Candidate for Percutaneous Patent Foramen Ovale Closure? (Indications)
This treatment is for those diagnosed with “cryptogenic stroke (stroke of unknown cause)”. As the frequency of stroke due to atherosclerosis and atrial fibrillation increases with age, the treatment is generally for those under 60 years old. Having a “patent foramen ovale” is a prerequisite for catheter treatment, but young people diagnosed with stroke who have not been checked for patent foramen ovale can also consult us. Also, stroke through a patent foramen ovale is thought to occur when an embolus passes through the patent foramen ovale. As the embolus is more likely to pass through the patent foramen ovale when abdominal pressure increases, such as when standing up suddenly, those who developed stroke at such times may have been due to a patent foramen ovale. Additionally, migraine is associated with patent foramen ovale, so “young stroke patients with migraine accompanied by visual symptoms” are recommended to be tested for the presence of patent foramen ovale.
Strengths of St. Luke's International Hospital
Interdepartmental Collaboration
We hold Brain Heart Conferences with neurologists including stroke specialists. As this treatment is for stroke prevention, and it’s necessary to consider the cause and risks of stroke when determining the treatment plan, we have a system that easily reflects expert opinions from the neurology field. Also, as we target patients with high surgical risks, management of comorbidities is essential. Our hospital has many departments and values interdepartmental collaboration, allowing patients to receive specialized support for conditions other than heart diseases with peace of mind.
Safe, Secure, and Comfortable Recovery Environment with All Private Rooms
If the postoperative course is favorable, patients are transferred to the general ward the day after surgery. All our general wards are private rooms, allowing for a quiet and relaxed hospital stay. Not only is your privacy protected, but we also provide a safe and secure environment that can reduce the risk of infection from other patients.
