PFO Closure: Procedure, Recovery, Risks & Aftercare

What Is a Patent Foramen Ovale (PFO)?

A patent foramen ovale (PFO) is a small opening between the right and left atria. Before birth, this opening allows blood to bypass the lungs. It normally seals shut within the first few months of life, but in about 1 in 4 adults it remains open. Most people with a PFO never have any problems, but in some cases, a small blood clot can cross from the right to the left side of the heart and travel to the brain, causing a stroke.

How Does the PFO Closure Procedure Work?

"Percutaneous" means the procedure is done through the skin, not with open-heart surgery. A thin, flexible tube (catheter) is inserted into a vein, usually in the groin, and guided to the heart. A small, umbrella-shaped device is then placed across the PFO to seal it. Over time, the body's own tissue grows over the device, permanently closing the opening.

• Usually a same-day or overnight procedure
• Performed with local anesthesia and light sedation
• Success rates are very high; serious complications are uncommon

How common is a PFO by age group?

A PFO is one of the most common heart findings. About 1 in 4 adults (20-25%) has a PFO.

• Newborns & infants: Nearly everyone is born with this opening; it usually closes within a few months.
• Children: The opening becomes less common as many close naturally during early childhood.
• Young adults: About 1 in 3 people in the first few decades have a PFO. This is the age group where it is most often found. When a stroke occurs in a younger person without another clear cause, a PFO is present about half the time.
• Middle-aged adults: About 1 in 4 adults has a PFO.
• Older adults: PFO becomes somewhat less common (roughly 1 in 5 in the oldest groups), though when present, the opening tends to be slightly larger.

Having a PFO does not mean a person will have problems. Closure may be considered for selected patients who have experienced a PFO-associated or otherwise unexplained ischemic stroke after evaluation for other potential causes. Eligibility depends on factors including age, stroke characteristics, PFO anatomy, competing stroke risks, and individual clinical circumstances.

Who Is a Candidate for PFO Closure?

The main reason to close a PFO is to lower the chance of another stroke in someone who has already had a stroke that could not be explained by any other cause (cryptogenic stroke). It is not recommended for most people who simply have a PFO found by chance. The decision is made by a team that may include a cardiologist and a neurologist, weighing the potential benefit against the small risks of the procedure.

PFO Closure Risks and Possible Complications

PFO closure is generally considered a minimally invasive procedure, but complications can occur. Your cardiology team should discuss your individual risks and expected benefits before the procedure.

• Bleeding or bruising at the catheter insertion site
• Blood-vessel complications
• Irregular heart rhythms, including atrial fibrillation
• Blood clot formation on the closure device
• Device movement or other device-related complications
• Infection
• Rare serious cardiovascular or neurological complications

PFO Closure Recovery: What to Expect After the Procedure

• Recovery site: Small puncture in the groin; some bruising and mild soreness are normal.
• Activity: Avoid heavy lifting, straining, and vigorous exercise for about a week. Keep the insertion site clean and dry.
• Watch the insertion site: Call your care team for increasing pain, swelling, a growing lump, redness, warmth, drainage, or bleeding that does not stop with gentle pressure.
• Return to normal life: Most people return to usual daily activities within a few days to a week.

Medications after PFO Closure

Blood-thinning medicines are used to prevent clots from forming on the device while the body's tissue grows over it.

• Common plan: Dual antiplatelet therapy (aspirin + clopidogrel) for the first 1 to 6 months, followed by a single antiplatelet (often aspirin) for a longer period.
• Some people who need an anticoagulant for another condition will stay on that instead.
• Antibiotics before certain dental or surgical procedures may be recommended for the first several months after closure to protect the device from infection.
• Take all medicines exactly as prescribed; do not stop on your own. Stopping early can raise the risk of a clot on the device.

PFO Closure Complications and Warning Signs

Call your care team or seek emergency help right away if you experience:

• Sudden weakness or numbness of the face, arm, or leg (especially on one side)
• Sudden trouble speaking, understanding speech, or confusion
• Sudden vision loss, severe headache, dizziness, or loss of balance
• Chest pain, a racing or irregular heartbeat, fainting, or shortness of breath
• Fever, or redness/drainage/swelling at the catheter site

Staying healthy after closure

Closing a PFO lowers stroke risk, but it does not remove every risk. Keeping your heart and blood vessels healthy remains important for life:

• Control blood pressure, cholesterol, and blood sugar with the help of your doctor.
• Do not smoke, and avoid secondhand smoke.
• Stay physically active once cleared; aim for regular moderate exercise.
• Eat a heart-healthy diet rich in vegetables, fruits, whole grains, and lean proteins; limit salt, and added sugar.
• Maintain a healthy weight and limit alcohol.
• Keep all follow-up appointments, including any recommended heart-rhythm checks or echocardiograms.
• Watch for an irregular heartbeat: A temporary irregular rhythm (atrial fibrillation) can occur after closure, usually in the first weeks. Report palpitations or a fluttering heartbeat to your care team.

Questions to ask your care team

• How long should each of my medicines be continued?
• When can I return to work, exercise, and driving?
• Do I need antibiotics before dental work, and for how long?
• When is my next follow-up and will I need another heart scan?