Cardiology Treatment & Procedures

Patent Foramen Ovale

What is a Patent Foramen Ovale

A Patent Foramen Ovale (PFO) is known as a hole in the heart. PFOs occur at birth and can be closed by Dr Peter Fahmy by using a catheterisation procedure. In fetal circulation, the foramen ovale is an opening that allows blood to bypass the lungs and go directly from the right atria to the left atria. Shortly after birth, the higher pressure in the left atria and the lower pressure in the right atria causes permanent closure of the foramen ovale in most people. In approximately 25% of people, the foramen ovale fails to close and could lead to a cryptogenic stroke.

Can a​ closure reduce your risk of having a stroke?

Many times a PFO is not discovered until adulthood. If a doctor found a PFO, it is important to speak with your healthcare professional to see if closing the hole in your heart can help reduce stroke risk.

What is an unidentified stroke?

If you had a stroke with no identifiable cause, your doctor might conclude that you have a PFO. If this has occurred, your PFO would have caused a blood clot to pass from the right side of your heart to the left side of your heart, blocking a blood vessel that supplies the brain and causes a stroke.

Treatment for Patent Foramen Ovale

Catheter-based procedure to close the Patent Foramen Ovale:

  • The procedure takes approximately one to two hours
  • A local anesthetic is used at the site where the closure device is introduced to the body (usually a vein in the right groin area), along with general anesthesia or conscious sedation
  • During this procedure, a catheter is inserted through a vein in the leg which goes up to the heart, and the closure device is inserted to fix this hole in the heart
  • Hospitalisation is six to 24 hours

Medical Management

  • Your doctor may prescribe blood-thinning medication to reduce the chance that clots form in your blood

Surgical closure of the PFO

  • Surgical repair involves directly suturing a patch over the PFO. Surgical PFO closure is rarely performed today following a cryptogenic stroke

Complications

What are the potential risks of the procedure?

As with any medical procedure, there is a possibility of complications due to the device and/or the procedure. Potential risks include, but are not limited to:

Most common

  • A noticed or unnoticed rapid or irregular heartbeat
  • Headache or migraine
  • Dizziness or abnormal sensation
  • Chest pain or discomfort
  • Upper respiratory infection
  • Back pain • Nausea
  • High or low blood pressure
  • Pain at the incision site
  • Difficulty breathing
  • Bleeding
  • Fatigue
  • Anxiety

Most serious

  • Death
  • Stroke (major or minor)
  • Heart attack
  • Kidney failure
  • Clot formation or blood vessel blockage due to clots or air
  • Injury to the heart or blood vessels
  • Perforation of the heart muscle or blood vessels
  • Blood or fluid build-up between the heart and the sac covering the heart
  • Infection

Other

The movement of the device from its position in the Patent Foramen Ovale to other parts of the body may cause you to have a second surgical or interventional procedure.

Other Cardiology Services

TAVI (Tranascatheter Aortic Valve Insertion)

Transcatheter aortic valve implantation (TAVI) is a procedure that allows an aortic valve to be implanted using a long narrow tube called a catheter. Usually, the catheter is inserted into a large blood vessel in your groin or through a small incision in your chest.

Percutaneous Coronary Intervention (PCI)

Percutaneous Coronary Intervention (PCI) is sometimes called, an angioplasty with stent. PCI is a non-surgical procedure that uses a catheter to place a stent in the blood vessel of the heart that has been narrowed by plaque build-up.

Adjunctive imaging can also be used to further assist in coronary intervention such as IVUS and OCT.

Diagnostic imaging such as Intravascular Ultrasound (or IVUS) lets cardiologists see inside a coronary artery in real time, yielding information beyond routine imaging methods such as coronary angiography or non-invasive Multislice CT scans.

Intravascular optical coherence tomography (OCT) can add value to angiography as a diagnostic and/or intervention tool for percutaneous coronary intervention (PCI) guidance.

Rotablation

This is a procedure which attempts to “bore out” a narrowing in a coronary artery which might not otherwise respond to stenting.

Intravascular Ultrasound

Intravascular Ultrasound (or IVUS) lets cardiologists see inside a coronary artery in real time, yielding information beyond routine imaging methods such as coronary angiography or non-invasive multislice CT scans.

Patent Foramen Ovale (PFO)

The heart is divided into four chambers. The upper chambers are called the right and left atria. The lower chambers are the right and left ventricles. In fetal circulation, the foramen ovale is an opening that allows blood to bypass the lungs and go directly from the right atria to the left atria. Shortly after birth, the higher pressure in the left atria and the lower pressure in the right atria causes permanent closure of the foramen ovale in the majority of people. A PFO occurs when the opening does not close. This opening can allow blood to pass from the right atria to the left atria. Many times a PFO is not discovered until adulthood.

PFO’s are suspected to be a cause of cryptogenic stroke (a stroke that cannot be linked to a specific cause). Some research suggests there may be a link between PFO’s and migraine headaches.

Atrial Septal Defect (ASD)

An ASD is a hole in the part of the septum that separates the atria—the upper chambers of the heart. This heart defect allows oxygen-rich blood from the left atrium to flow into the right atrium instead of flowing to the left ventricle as it should. Many children who have ASDs have few if any, symptoms.

Ischemic Heart Disease

Ischemic heart disease occurs when there is reduced blood supply to the heart.

Structural Heart Disease (SHD)

People with structural heart disease fall into two categories:

  1. People are born with the disease – i.e. a hole within the chambers of the heart
  2. They acquire  SHD through wear and tear – i.e. a tight or leaky heart valve.
Heart Failure

Heart failure occurs when the heart muscle has become too weak or too stiff to pump blood through the body as effectively as normal.

Arrhythmias

Heart arrhythmia refers to a group of symptoms where the heartbeat is irregular, too slow, or too fast. Arrhythmias are broken down into:

  • Slow heartbeat (bradycardia).
  • Fast heartbeat (tachycardia).
  • Irregular heartbeat (flutter or fibrillation).
  • Early heartbeat (premature contraction).