What is transcatheter closure of a patent foramen ovale?
Transcatheter closure is a procedure that seals a small hole in the heart without surgery. The medical term for the hole is patent foramen ovale. The device that seals the hole looks like two umbrellas joined together at their centers. It is placed in the heart through a catheter (thin tube).
This procedure reduces the risk that a blood clot will cause a stroke or other problem.
When is it used?
Transcatheter closure may be done if you have a small hole in your heart and medicine has not helped. The hole can be dangerous. Sometimes blood clots form in veins. A clot may travel through the bloodstream to the right side of the heart and then pass through the hole into the left side of the heart. It may be pumped out of the heart and get stuck in an artery. If the clot gets stuck in an artery in the brain, it can cause a stroke.
How do I prepare for this procedure?
- Plan for your care and recovery after the operation. Allow for time to rest. Try to find other people to help you with your day-to-day duties. If you are going home the same day as the procedure, arrange to have someone drive you home.
- Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It’s best to quit 6 to 8 weeks before surgery.
- You may or may not need to take your regular medicines the day of the procedure. Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Tell your healthcare provider about all medicines and supplements that you take. Ask your provider if you need to avoid taking any medicine or supplements before the procedure.
- Your healthcare provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
- Follow any other instructions your healthcare provider gives you.
What happens during the procedure?
The procedure will take place in a room called a cardiac catheterization lab. Usually you will be given a sedative, which is medicine that relaxes you, but you will stay awake during the procedure. Often, you will have a test called a transesophageal echocardiogram (TEE) to allow your healthcare provider to check the size of the hole and to be sure there are no blood clots in the heart.
You will have a shot that numbs the skin over a large vein in your groin. Your healthcare provider will make a small cut in the numbed skin. He or she will insert a catheter through the cut and into the vein. Guided by X-rays, the healthcare provider will push the catheter into the hole in your heart. As the device used to close the hole is then pushed out of the catheter, the first umbrella will open in the left side of the heart. The catheter will be pulled back so the umbrella is snug against the wall of the heart where the hole is. Next, the rest of the device will be pushed out of the catheter, and the second umbrella will open on the right side of the heart. You will now have 1 umbrella on the left side of the hole, a small connector in the hole, and another umbrella on the right side of the hole. When your provider is sure the device is in the right place, he or she will remove the catheter.
You will have pressure applied to the puncture site in your groin until bleeding stops. You will be able to get out of bed in about 4 hours, after the sedative has worn off.
What happens after the procedure?
You may be able to go home the same day. Usually you will need to take aspirin or other medicine for up to a year. The medicine will help prevent blood clots from forming on the device. Your healthcare provider may prescribe antibiotics for a few days after the procedure, or to be taken when you have dental treatments.
Ask your healthcare provider:
- How long it will take to recover
- What activities you should avoid and when you can return to your normal activities
- How to take care of yourself at home
- What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.
What are the risks of this procedure?
Every procedure or treatment has risks. Some possible risks of this procedure include:
- The device may come loose and travel into the lungs or another part of the body.
- The procedure might not work because the hole is not closed completely.
- You may have a stroke or heart attack during the procedure.
- You might have abnormal heart rhythms.
- You may have infection, bleeding, or blood clots.
- The procedure may damage a heart valve or cause a new hole in the heart.
Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.
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