The wall separating the heart's two upper chambers is called the atrial septum. Both a patent foramen ovale (PFO) and an atrial septal defect (ASD) allow blood to pass through this wall, but they develop differently.
Before birth, an opening between the upper chambers lets blood bypass the lungs. The flap over this opening usually seals after birth. When it doesn't seal completely, it's called a PFO. PFOs are common and usually cause no problems. Many people never know they have one.
This gap in the tissue separating the upper chambers is present from birth. Blood usually flows through it from left to right, sending extra blood through the right side of the heart and the lungs. A larger ASD can gradually enlarge the right heart, even when symptoms are mild.
Call triple zero (000) for severe, worsening or persistent chest pain, or chest discomfort with breathlessness, sweating, nausea or pain spreading to your arm, jaw or back.
Do not wait for a routine appointment or drive yourself to hospital.
Before treatment, heart scans show the opening and whether a device can fit securely. A transoesophageal echocardiogram (TOE) uses an ultrasound probe in the food pipe to give a close view. A bubble study during a heart ultrasound may help identify a PFO by showing whether tiny bubbles injected into a vein cross between the chambers.
Device closure takes place in a hospital catheter laboratory. ASD closure usually uses a general anaesthetic, so you're unconscious during the procedure. PFO closure may use a general anaesthetic, or a local anaesthetic to numb the groin and sedation to make you relaxed and drowsy. With sedation, you may be awake for parts of the procedure. Follow the hospital's fasting and medicine instructions.
The doctor guides a thin tube called a catheter through a groin vein to the right upper chamber and across the opening. The folded device travels inside it and opens into two connected discs, one on each side of the wall, holding the PFO flap shut or covering the ASD gap. X-ray and ultrasound images help the doctor check its position and the seal before releasing it.
The doctor removes the catheter and leaves the device permanently in place. Staff press on the puncture site to stop bleeding, then apply a dressing.
A blood clot in a vein can travel to the right upper chamber and sometimes cross a PFO to the left upper chamber. From there, it can travel with blood pumped towards the brain and cause a stroke. Finding a PFO after a stroke doesn't prove it was the cause. Doctors first investigate other possibilities, including atrial fibrillation, an irregular heart rhythm.
Closure may reduce the chance of another stroke when the PFO is the likely cause. A stroke specialist and a cardiologist assess the brain scans, the details of the PFO, your age and medical history together. Most trial evidence comes from adults aged 18 to 60; the benefit in older adults is less certain, so decisions need individual assessment.
An ASD may need closing when extra blood flow is enlarging the right side of the heart, even if you feel well. The aim of closure is to stop this extra flow. Breathlessness or reduced ability to exercise can also be part of the decision. A small ASD that isn't affecting the heart may only need follow-up checks.
The cardiologist measures the opening, checks the surrounding tissue and assesses pressure in the lung arteries. Very high lung pressures can make closure unsuitable.
Some ASDs are too large, sit in a different part of the wall, or lack enough surrounding tissue to hold a device securely. Surgery can close these openings with stitches or a patch under a general anaesthetic. Recovery usually takes longer because the surgeon needs to reach the heart through the chest.
For a PFO, medicines can reduce blood clotting without closing the flap. Closure doesn't treat other causes of stroke, so treatment for high blood pressure or atrial fibrillation may still be needed.
You'll rest in a recovery area while staff check your heart rhythm and groin puncture site. Before you leave, the hospital gives you advice about driving, work and exercise that takes account of your recovery and any previous stroke.
Over the following months, heart tissue grows over the device and helps seal the opening. Medicines such as aspirin or clopidogrel reduce the chance of a clot forming on the device during healing. You'll be given a plan for which medicines to take and how long to take them. Don't stop them without advice from the treating doctor.
Follow-up heart scans check that the device is in position and look for any blood still passing through the opening. A remaining leak may need further assessment or treatment.
Bruising or soreness around the groin can occur. Some people develop an irregular heartbeat, including atrial fibrillation, which may need treatment.
Less common but serious risks include significant bleeding, injury to the heart or a blood vessel, a clot or stroke, or the device moving from its position. A complication may require another procedure or surgery.
After discharge, seek medical advice promptly for fever or increasing pain, swelling or bleeding at the puncture site. Follow the hospital's instructions about symptoms that need urgent care.
Your GP or specialist can refer you to a Heartscope cardiologist to discuss a PFO or ASD and your test results. If closure may help, the cardiologist can refer you to a hospital specialist. Heartscope doesn't perform these procedures at its clinics. The clinic can answer questions about the consultation.
Consultations are privately billed. If you're eligible, Medicare pays part of the consultation fee when you have a valid referral from your GP or specialist. The clinic will confirm the amount left to pay before the visit.
Hospital, procedure and anaesthetic fees are separate from the Heartscope consultation. The hospital or treating provider confirms those costs.
Heartscope cardiologists see patients at clinics in Melbourne and Queensland. If you have a referral, our team can confirm the location and appointment details.
View clinic locationsNo. Closure is done in hospital. Heartscope cardiologists may be able to see patients with a valid referral from their GP or specialist, and can refer you to a hospital specialist when appropriate.
Usually not. A PFO found by chance often needs no treatment. A doctor may consider closure in particular circumstances, but having an opening alone isn't a reason to close it.
Closure isn't routinely recommended for migraine. Although migraine with aura and PFO can occur together, the benefit of closure for migraine remains uncertain.
Call triple zero (000) immediately for a drooping face, arm weakness or trouble speaking, even if the symptoms pass. This advice is the same before and after closure.
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