Patent foramen ovale closure (PFO)

This procedure is a non-surgical method of closing the tunnel in the atrial septum, using an implantable umbrella-type closure device (watchman procedure). The procedure is conducted in an angiography suite (“cath lab”) at Intra. Your interventional cardiologist will be assisted by nurses and other skilled staff. 
The PFO occluder is delivered through a catheter (a small plastic tube used to access the heart) via an incision in the groin, using x-ray guidance. The doctor positions the occluder to expand each disc on either side of the tunnel, thereby sealing it closed. 

PFO occluders are made of nitinol, a wire mesh made from an alloy of nickel and titanium shaped into two flat discs and a middle, or “waist” which straddles the septum.  Polyester fabric inserts help close the hole and provide a foundation for growth of tissue over the occluder after placement.


What will I experience during the procedure?

  • An intravenous catheter (IV line) for administration of fluids and medication will be inserted into a vein on the back of your hand or in your arm.
  • Devices to monitor your heart rate and blood pressure will be attached to your body.
  • You will be awake but lightly sedated throughout the procedure.
  • You will feel the sting of local anaesthetic injection into the groin region, where the incision will be made to insert the catheter.
  • During your procedure a small amount of dye (contrast media) may be injected to visualise the placement of your device. You may experience a warm feeling as the contrast passes through your body.

You should tell your interventional cardiologist if you are experiencing any pain during the procedure. Usually patients have little or no discomfort during this procedure. Severe pain is very rare.

How should I prepare for the procedure?

  • Fasting: You may eat until 2 hours before admission then you should not have anything to eat. You may continue to drink clear fluids.
  • Allergies or previous reactions to contrast (x-ray dye): Please inform Intra staff at the time of booking your procedure if you have any known history of allergies, particularly allergies to x-ray contrast and seafood.
  • Diabetes: If you are a diabetic you should tell the Intra staff at the time of booking. You may need to discuss your insulin dose with your cardiologist.
  • Warfarin or Coumadin: If you are taking Warfarin (a “blood thinner”) you should make this known to Mercy Angiography staff at the time of booking. It is likely that you will need to stop this medication temporarily for a few days before angiography.
  • Other usual medications: Continue these unless advised otherwise by your cardiologist

Please bring with you any medication and any recent blood test results, ultrasound results or x-rays.

What happens after the procedure?

  • Following the procedure, you will go to the hospital ward to recover from sedation.
  • If there are no complications, upon the discretion of your cardiologist, you may go home on the same day as your procedure or you may require an overnight stay in the hospital.
  • Before leaving the hospital, an echocardiogram will be performed to ensure the device positioned properly.
  • Prior to your discharge the cardiologist and / or ward staff will provide you guidelines or advice about resuming your normal daily activities. 

What are the benefits and risks?

  • Your chance or further stroke is significantly decreased
  • Surgery to close your PFO is avoided resulting in a shorter hospital stay and substantially reduced recovery time.
  • You may not need life-long drug therapy to prevent strokes.
  • If you suffer from migraines, you may notice a reduction in symptoms.
Potential risks include:
  • PFO closure is generally a straight-forward safe procedure and serious complications are uncommon.
  • A small amount of bruising at the catheter entry point in the groin region is relatively common. This is usually not clinically important unless it becomes painful.
  • You procedure involves a puncture in the groin region. Very occasionally a "false aneurysm" or out-pouching of the groin artery deep under the skin occurs at the puncture site. This shows up as increasing pain at the puncture site. The diagnosis is made by an ultrasound test and treatment is usually by an injection.
  • Abnormal or irregular beating of the heart may occur but is usually brief and easily treated.
  • An allergic reaction to the x-ray contrast (dye) with rash or itching occasionally occurs. Exceptionally rarely a very severe life-threatening allergic reaction can occur.
  • A heart attack is a very rare complication.
  • The x-ray contrast may cause some damage to kidneys that is usually temporary. It is more common in those patients who already have damaged kidneys or who suffer from diabetes.
  • Infection is very rare.
  • If you have chest pain in hospital after the procedure you should report this. Most chest pain turns out to be unimportant.
  • Stroke or death is very rare.