Most people with a patent foramen ovale don’t need treatment. In certain circumstances, however, your doctor may recommend that you have a procedure to close the patent foramen ovale.
Reasons for closure
If a patent foramen ovale is found when an echocardiogram is done for other reasons, a procedure to close the opening usually isn’t performed.
The commonest reason for PFO closure is for stroke prevention. This has been shown to be an effective treatment in those who have had a stroke/mini-stroke (TIA) at a young age, with no other cause identified (cryptogenic stroke). The most recent studies have shown that closure of PFO in strokes with no other cause, reduces the risk of another stroke, and is superior to treating with medications alone.
Procedures to close the patent foramen ovale may be done in other circumstances, such as to treat low blood oxygen levels linked to the patent foramen ovale, history of decompression illness (the bends) in deep sea divers or a blood clot travelling from the right to left side of the heart (paradoxical embolism).
Closure of a patent foramen ovale to prevent migraines isn’t currently recommended.
Procedures for closure
Device closure: Using cardiac catheterisation, doctors can insert a device that plugs the patent foramen ovale. In this procedure, the device is on the end of a long flexible tube (catheter).
The doctor inserts the device-tipped catheter into a vein in the groin and guides the device into place with the imaging assistance of an echocardiogram.
Although complications are uncommon with this procedure, a tear of the heart or blood vessels, dislodgement of the device, or the development of irregular heartbeats may occur.
Surgical repair: A surgeon can close the patent foramen ovale by opening up the heart and stitching shut the flap-like opening. This procedure can be conducted using a very small incision and may be performed using robotic techniques.
If you are undergoing surgery to correct another heart problem, your doctor may recommend that you have the patent foramen ovale corrected surgically at the same time. Research is ongoing to determine the benefits of closing the patent foramen ovale during heart surgery to correct another problem.