Patent foramen ovale (PFO) is a common cardiac condition where the foramen ovale – a normal opening between the atria in fetal life – persists into adulthood. While many people with PFO remain asymptomatic, it has been associated with cryptogenic stroke (stroke of unknown cause). Livasa Hospital evaluates PFO-related stroke risk and provides percutaneous closure when indicated.

Understanding Patent Foramen Ovale

During fetal development, the foramen ovale is a normal opening in the atrial septum allowing blood to bypass the non-functional lungs. After birth, the flap-like septum primum typically closes against the septum secundum when pressure relationships change.

Persistent PFO – In 20–25% of adults, this closure is incomplete, allowing potential right-to-left shunting, particularly during activities that increase right atrial pressure (Valsalva, coughing, straining).

Mechanism of Stroke in PFO

PFO increases stroke risk through:

• Paradoxical embolism – Blood clots from the venous system bypassing the lungs to reach the cerebral circulation

• Arrhythmias – Associated atrial fibrillation

• Inflammation – Chronic stimulation of endocardium

Clinical Presentation

Most PFO patients are asymptomatic, discovered incidentally. PFO is clinically relevant when:

• Cryptogenic stroke – Stroke without identified cause; PFO found on evaluation

• Recurrent TIA – Transient ischaemic attacks suggesting embolism

• Unexplained hypoxaemia – Right-to-left shunting in some patients

Diagnostic Evaluation

PFO is detected through:

• Transoesophageal echocardiography (TOE) – Gold-standard; directly visualises PFO and shunt magnitude

• Bubble study – Contrast-enhanced ultrasound showing right-to-left passage

• Transcranial Doppler – Detects microemboli suggesting right-to-left shunting

Indications for PFO Closure

PFO closure is considered for:

• Cryptogenic stroke with PFO – Suspected paradoxical embolism

• Recurrent stroke despite anticoagulation – Failed medical therapy

• Peripheral embolism – With PFO and no other source

• Diving or altitude exposure – Occupational risk in PFO with shunt

• Planned Valsalva activities – High-risk situations in some patients

Management Without Closure

For asymptomatic PFO:

• Antiplatelet therapy (aspirin) generally recommended

• Conservative management is standard

• Closure generally not recommended without stroke history

PFO Closure Procedure

Percutaneous catheter-based closure is the standard approach:

Procedure:

1. Femoral vein access

2. Transoesophageal echocardiographic guidance

3. Device positioning across the PFO

4. Confirmation of complete closure and no complications

5. Device release

Device types:

• Septal occluders (most common)

• Septal closure devices with double disc design

• Surgical closure (rare; reserved for special circumstances)

Advantages:

• Minimally invasive

• No general anaesthesia

• Rapid recovery

• High success rates (>95%)

Post-Closure Management

Immediate:

• Observation for complications

• Transoesophageal echocardiographic confirmation

Early (4–6 weeks):

• Continued antiplatelet therapy

• Light activity restrictions

• Wound care

Long-term:

• Endocarditis prophylaxis (limited indications)

• Regular follow-up echocardiography

• Antiplatelet therapy continuation (often lifelong)

Expected Outcomes

• Procedural success >95%

• Significant reduction in recurrent stroke risk

• Good quality of life post-closure

• Low complication rates

Why Choose Livasa Hospital?

• Experienced interventional cardiologists

• Transoesophageal echocardiographic expertise

• Access to latest closure devices

• Comprehensive stroke prevention programs

• Integration with neurology for stroke patients

NAP – Contact Details

Livasa Hospital Mohali
Sector 71, Sahibzada Ajit Singh Nagar (SAS Nagar)
Mohali, Punjab – 160071
Phone: +91-80788 80788 (24/7 Emergency)
Website: www.livasahospitals.com

Call +91-80788 80788 to discuss PFO closure evaluation at Livasa Hospital.