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PFO and ASD Closure
PFO and ASD closure seal an opening between the heart's two upper chambers using a small device placed through a vein in the leg.
What it is
Before birth, a flap-like opening between the upper chambers lets blood bypass the lungs. It usually seals after birth. When it stays open, it is called a patent foramen ovale (PFO). About one in four adults has one, and most never know it. In some people, a PFO may let a small clot cross from the right side of the heart to the left and travel to the brain, causing a stroke. An atrial septal defect (ASD) is a true hole in the wall between the upper chambers. A larger ASD sends extra blood to the right side of the heart, which can enlarge it over years and cause shortness of breath, irregular heartbeat or high lung pressures. Both can often be closed with a device made of two small discs joined at the center.
Who it may help
PFO closure is mainly for selected adults, generally younger than 60, who have had a stroke with no other cause found after a full evaluation that includes a neurologist. Most PFOs do not need closing. ASD closure is considered for secundum ASDs that enlarge the right side of the heart or cause symptoms, when the size and edges of the hole allow a device. Imaging, often including a bubble study or transesophageal echocardiogram, guides the decision.
How it's done
A catheter is placed in the large vein at the top of the leg and guided to the heart. Using ultrasound from inside the heart (intracardiac echo) or from the esophagus (TEE), the doctor measures the opening and places the device so one disc sits on each side of the wall. The procedure often takes under an hour. Many patients go home the same day or the next morning.
Recovery
Most people return to normal activity within a few days. You will take antiplatelet medicine, such as aspirin, for several months while tissue grows over the device. Antibiotics are usually recommended before dental work for about six months. Follow-up echocardiograms check the device.
Risks
Possible risks include a fluttering or irregular heartbeat (most often in the first weeks), bleeding or injury to the leg vein, the device moving out of place, and stroke. Rarely, the device can wear into nearby heart tissue, or emergency surgery is needed. Your doctor will explain how these risks apply to you.
Dr. Smith's experience
Dr. Smith has been primary operator for more than 10 PFO and ASD closures since joining Cardiovascular Institute of the South in 2023, among more than 180 structural heart procedures. He is board certified in echocardiography, which is used to size the opening and guide the device.
Frequently asked questions
How common is a PFO?
Very common. About one in four adults has a PFO, and most never have a problem from it.
I had a stroke and was told I have a PFO. Do I need it closed?
Not always. Closure is considered when no other cause of the stroke is found after a full evaluation, usually including a neurologist. Your doctors will weigh your age, the stroke pattern and the PFO features.
Does PFO closure treat migraines?
PFO closure is not approved as a migraine treatment and is not routinely recommended for migraines alone.
Will I need blood thinners after the procedure?
Most patients take antiplatelet medicine, such as aspirin, for several months while the device heals in place. Your doctor will set the plan.
How long is recovery?
Most people return to normal activity within a few days. Avoid heavy lifting for about a week, or as directed.
Can I have an MRI after closure?
Most closure devices allow MRI under specific conditions. Always tell the MRI staff you have a heart device and carry your device card.
Ask about PFO or ASD closure at Cardiovascular Institute of the South
Dr. Smith sees patients at CIS Baton Rouge, 8401 Picardy Avenue · (225) 308-0247, and CIS Zachary, 6550 Main Street, Suite 1000 · (225) 654-1559. Your primary care doctor or cardiologist can also send a referral.