Transcatheter Closure of a Patent Foramen Ovale

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).

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, 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.

Besides medicines, an alternative to this procedure is to have heart surgery to sew the hole closed.

How do I prepare for the 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 healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before the procedure.

Follow any other instructions your healthcare provider gives you. Usually you will be asked to not eat or drink anything after midnight the night before the procedure.

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.

What are the benefits?

This procedure reduces the risk that a blood clot will cause a stroke or other problem. It is not yet known if the procedure is more effective than anticoagulant medicines.

What are the risks?

  • 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 get an infection.
  • The procedure may damage a heart valve or cause a new hole in the heart.

When should I call my healthcare provider?

Call your provider if:

  • You develop any chest pain.
  • You get severe pain in the leg where the tube was inserted.
  • You have bleeding from the puncture site.
  • You have increased swelling or tenderness in the puncture area.

Written by Edward Havranek, MD, for RelayHealth.
Published by RelayHealth.
© 2012 RelayHealth and/or its affiliates. All rights reserved.