Patent foramen ovale (PFO) closure

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.

Before the procedure

Fasting Please stop eating four hours before your procedure time. You may continue to drink clear fluids (water, weak BLACK tea and weak BLACK coffee) up to two hours before your procedure time. Do not consume milk as this is considered food. You may take your regular medications with sips of water.

Allergies Please tell Intra staff at the time of booking if you have any food or medication allergies or previous reactions to X-ray contrast (dye).

Diabetes If you are a diabetic, please tell Intra staff at the time of booking. You may need to discuss your insulin/diabetes medication dose with your cardiologist.

Anticoagulation (blood thinner) If you are taking a blood thinner (e.g. warfarin, rivaroxaban, dabigatran, etc.), please advise Intra staff at the time of booking who will instruct you regarding continuation.

Other regular medications Continue these unless advised otherwise by your cardiologist. If you are taking a diuretic or water pills (e.g. frusemide, spironolactone) please advise Intra staff as you may need to withhold this on the morning of the procedure.


After the procedure

You will be transferred to CIU where the nurses will monitor your recovery. It is important you remain lying flat on the bed for the next few hours.

You will undergo an electrocardiogram (12-lead ECG) and echocardiogram before you go home to ensure the occluder device is in place and functioning well.

If appropriate you will be discharged after four hours after PFO closure.

What are the risks?

As with any procedure, there are potential risks involved. Your cardiologist will explain the procedure, discuss possible risks and answer any questions you may have. You will then be asked to sign the consent form. This will occur either at an earlier appointment, or on the day of your procedure.