Percutaneous closure of patent Foramen Ovale

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The foramen ovale is a small natural flap-shaped opening located in a very precise region of the interatrial septum, called the fossa ovale.

As already explained in the case of interatrial communications, the atria are not separated during intrauterine life and the last area that closes completely, usually between 6 months and the first year of life of the newborn, is the foramen ovale. . However, more frequently than you might think (it is estimated to occur in up to 20% of adults, one in every 4) the formina ovale does not close completely, a situation known as “patent formina ovale” (PFO).

Patent forma ovale usually does not cause symptoms and in the vast majority of cases it is either not diagnosed or is diagnosed accidentally in a test such as an echocardiogram performed for another reason. Most PFOs do not need any treatment, neither medical nor surgical. 

However, the presence of FOP can cause the phenomenon known as “paradoxical embolism”, that is, the passage into the systemic arterial circulation of small thrombi that can form in the veins, generally of the legs, causing a stroke or peripheral arterial ischemia. . There are professions or activities such as scuba diving in which sudden changes in pressure can increase the risk of ischemic complications in the case of FOP, especially when associated with an interatrial septal aneurysm. In these cases, treatment for the PFO may be considered, with percutaneous closure probably being the treatment in many cases.

The procedure is similar to atrial septal defect closure. It is performed under local anesthesia and with more or less deep sedation, since an intraprocedural transesophageal echocardiogram is usually needed to “guide” the closure of the defect. Through the femoral vein in the groin, a catheter is advanced first to the right atrium and then to the left atrium through the PFO. Next, a devil-shaped device, with two discs joined by a narrower part called the neck, is partially deployed through the catheter, releasing a first disc in the left atrium and the second disc in the right atrium, eventually closing thus the foramen ovale. The procedure is technically simple and with a low incidence of complications in expert hands. The hospital stay is usually short and recovery is immediate. Post-procedure antiplatelet treatment is usually necessary so that thrombi do not form at the device level.