Frequently Asked Questions

If you have been diagnosed with a patent foramen ovale (PFO) and have had an ischemic stroke of unknown cause, you are at risk of another stroke. To reduce the risk of another PFO-associated stroke, your doctors may recommend closing your PFO with a PFO occluder. Devices like these have been used to treat hundreds of thousands of patients around the globe, and are supported with many large clinical studies.^1,2

1. Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017; 377:1011-21.
2. Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017;377:1022-32.

When scheduling your procedure:

Tell your doctor what medicines you take. Include the dose for each medicine. Your doctor may ask you to change your medicine routine before your procedure.

The night before your procedure:

You may be told not to eat or drink anything after midnight the night before your procedure. Follow your doctor’s advice about eating, drinking, and taking medicine.

The day of your procedure:

Do not drive yourself to the hospital. Have someone else drive you there and home. You may want to ask someone to help you at home.

First you will receive a sedating medicine to help you relax. You will also receive a local anesthetic. Once you are relaxed and comfortable, your doctor will begin the procedure.

Your doctor will make a small incision (cut) and insert a tube called a catheter into your groin area. The PFO occluder travels inside the catheter. Your doctor will guide the catheter through your body to your heart.

Then your doctor will place the PFO occluder across your PFO. Cardiac imaging tools will help your doctor confirm that the occluder is in the right position before removing the catheter. Then your doctor will remove the catheters. The occluder will stay in your heart.

You will be resting in the recovery room in about 2 hours.

PFO closure is not open heart surgery and is considered a 'minimally invasive' procedure.

You should expect to be home within 24 hours. Your doctor will talk to you about your care before you go home. Your doctor may recommend a routine like the one described here.

For one month after your procedure:

• Aspirin (81 to 325 mg) every day
• Clopidogrel (75 mg) every day

For at least six months after your procedure:

• Aspirin (81 to 325 mg) every day
• Additional medicine prescribed by your doctor

Six months after your procedure:

• An echocardiogram

Ongoing guidance:

• Visit your doctor for regular check ups.
• Contact your doctor if you have any bleeding, pain, discomfort, or changes in your overall health.
• For your safety and to avoid damage to your occluder:
  • Tell all medical professionals that you have had PFO closure.
  • Talk about your implant BEFORE you have any imaging procedures: medical, dental, or MRI (magnetic resonance imaging).

You should avoid strenuous physical activity for at least 2 weeks after your procedure. Your doctor will provide you with more information.

Your PFO occluder will not be affected by household appliances or security systems. Tell all your doctors, including your dentist, that you have a PFO occluder. If you need medical imaging, tell the technician that you have a PFO occluder. The device may reduce the clarity of your medical images.

Most PFO occluders contain a nickel-titanium alloy. This is considered safe for most people. It may not be the right choice for people who are allergic to nickel or who have allergies to metal. Talk to your doctor to determine the right treatment option for you.

A heart specialist (cardiologist) looks at results of a test called an echocardiogram (pronounced eck-oh-kar-dee-oh-gram). This test uses sound waves to create pictures of your heart. These pictures can show if there is a problem with the way the heart is formed. They can also show if there is a problem with the way blood flows through the heart.

A cardiologist may want a detailed look at blood flow in the heart. They do this through a bubble study and it is another way a doctor looks for a PFO.

Your doctors will do everything they can to find the cause of your stroke. However, the cause of ischemic stroke is not known in 30% of people.

Your neurologist and cardiologist will gather information about your brain, heart, and blood vessels. The following tests may be used to collect images and other health information:

• Ultrasound
• CAT Scan (CT)
• Magnetic Resonance Imaging (MRI)
• EKG/ECG
• Blood tests

About 1 in 4 people have a PFO.¹ Most do not have a stroke. However, you had an ischemic stroke and now your doctors know you have a PFO. There may be a link. Your doctors will evaluate you to see if you had a PFO-associated stroke.

In some cases, a PFO plays an important role in causing stroke. A PFO can permit a blood clot to pass from the right atria to the left atria in the heart. If the clot blocks a blood vessel that supplies the brain, it causes an ischemic stroke. Read more about PFO and stroke here.

1. Kent DM, Thaler DE. Is patent foramen ovale a modifiable risk factor for stroke recurrence? Stroke. 2010;41(10 Suppl):S26-30. doi: 10.1161/STROKEAHA.110.595140.

PFO closure can often be done as an outpatient procedure and should last between 1 and 2 hours. It is often done without general anesthesia. You can expect to go home the same day.

Be sure to talk with your doctor about any medication you may be taking, as they may advise you to adjust your medication before the procedure. Your doctor may tell you not to eat or drink anything after midnight prior to the procedure. You should arrange for a ride to and from the hospital and ask someone to help you at home (if necessary).

This minimally invasive procedure will take place in a heart catheterization laboratory. Before beginning the procedure, you will receive a sedating medication to help you relax and a local anesthetic so that you don’t feel any significant discomfort. The catheter-based procedure involves making a tiny cut, typically in the right groin area, and inserting a small tube to guide the PFO occluder through the blood vessels to close the PFO within your heart.

Once the PFO occluder is placed across the PFO, the cardiologist will carefully study its position using cardiac imaging tools. When the cardiologist is satisfied with the position of the device, it will be released to remain permanently in the heart, and all catheters will be removed.

Within a few days of the procedure, your body’s own tissue will start to grow over the PFO occluder. The device becomes embedded in your heart, where it may stay permanently.

The goal of PFO closure is to reduce the risk of your having another stroke. Studies show that PFO closure significantly reduces this risk.^1,2 There have been multiple studies that have compared the experience of patients who received PFO closure along with medicine that reduces blood clots, to that of patients who only received medicine. The American Academy of Neurology analyzed the results of these studies and concluded that PFO closure plus medicine reduces the risk of a second stroke by 59% compared to medicine alone.³

1. Mas J-L, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377:1011-21.
2. Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017;377:1022-32.
3. Messé SR, Gronseth GS, Kent DM, et al. Practice Advisory update summary: Patent foramen ovale and secondary stroke prevention. Neurology. 2020;94:876-885.

As with any medical procedure, there is a possibility of complications. The most serious risks include:

• Blood clot in the heart, leg or lung, requiring long-term anticoagulation therapy
• Blood or fluid build-up between the heart muscle and the sac that covers the heart, requiring a drainage procedure
• Irregular and/or rapid heart rate (particularly atrial fibrillation)
• Perforation of the heart muscle or vessels
• Stroke (major or minor)
  
• Death

Additional potential risks associated with the procedure or the occluder include:

• Allergic reaction to anesthesia
• Allergic reaction to the contrast dye used to visualize the heart during the procedure
• Allergic reaction to a drug used during the procedure
• Allergic metal reaction: Nitinol (nickel, titanium), platinum/iridium, stainless steel (chromium, iron, manganese, molybdenum, nickel)
• Irregular heart rhythm
• Bleeding
• Blood clot on the occluder
• Blood vessel blockage due to blood clots or air
• Chest pain
• Fever
• Fluid buildup around lungs
• Headache or migraine
• Heart attack
• Heart valve damage that interferes with valve closure
• High or low blood pressure
• Incomplete closure of PFO
• Infection
• Injury to the heart or vessels
• Injury to the nerves in the arm or lower neck
• Movement of the occluder from its position within the PFO or to other parts of the body
• Sudden interruption of blood flow to an organ or body part
• Surgery or intervention to remove the occluder
• Trouble or inability to breathe

Your doctor will check to make sure that you do not have:

• A tumor or blood clots that would block delivery or placement of the occluder
• Blood vessels that are too small to allow for delivery of the occluder
• A body organ such as the heart, blood vessels, or heart valves that would interfere with the required device size
• Other types of heart defects
• A heart infection or inflammation of the heart