PFO Closure

A patent foramen ovale (PFO) is a small flap-like opening between the two upper chambers of the heart, present in around a quarter of adults. It usually causes no problems. In selected younger patients who have had a stroke with no other explanation, it can allow a clot to pass from the veins to the brain — and closing it reduces the risk of a further stroke.

How it works

  • Access: through the femoral vein in the groin.

  • Anaesthetic: sedation or general anaesthesia.

  • Delivery: a double-disc device is advanced across the PFO and opened on either side of the septum, sealing the opening. Heart tissue grows over the device in the months afterwards.

  • Duration: the procedure usually takes under an hour.

Who it suits

  • Age 18 to 60 — the range in which the evidence is strongest.

  • An ischaemic stroke confirmed on brain imaging, with no other cause found after full investigation and prolonged rhythm monitoring excluding atrial fibrillation.

  • A large right-to-left shunt, or an atrial septal aneurysm, on echocardiography with a bubble study.

  • No competing cause such as significant carotid disease, small vessel disease or a thrombophilia. Current evidence does not support closure where the PFO is unlikely to have caused the stroke, or outside the age range studied.

Risks and complications

  • Bleeding or bruising at the groin access site

  • Atrial fibrillation, most often in the weeks following the procedure

  • Device malposition, or a residual shunt

  • Clot forming on the device

  • Injury to the heart or surrounding structures

  • Stroke

  • Death

Every cardiac procedure carries risk. Your individual risk is assessed and discussed with you in detail before any decision is made.

After the procedure

  • Most patients go home the same day or the following day.

  • Antiplatelet therapy — aspirin, sometimes with clopidogrel for a period — is usually recommended. Long-term anticoagulation is not routine unless required for another reason.

  • Echocardiography confirms device position and closure at follow-up.

  • Endocarditis prophylaxis is advised for a period after implantation, and strenuous activity is limited briefly.

GP role

  • Refer patients under 60 who have had an ischaemic stroke or TIA with no cause identified.

  • Ensure prolonged rhythm monitoring has been completed — undetected atrial fibrillation changes management entirely.

  • Continue antiplatelet therapy as advised and review at follow-up.

  • Ask patients to report palpitations after the procedure promptly.