What is a PFO?
A patent foramen ovale is an opening that normally allows blood to pass between the upper heart chambers before birth. In some people, the flap does not seal completely after birth. This is common and usually causes no problems.
Occasionally a blood clot can pass through a PFO, reach the brain and cause a stroke. Finding a PFO does not, by itself, show that it caused a stroke.
Who may benefit from closure?
Closure may be considered after an ischaemic stroke (a stroke caused by a blocked blood vessel) when no more likely cause has been found and the PFO is thought to have played a part.
A stroke specialist and cardiologist review the brain and blood-vessel scans, your medical history and heart tests. Assessment may include a bubble-contrast heart scan, a scan through the gullet and heart-rhythm monitoring to look for atrial fibrillation.
Most PFOs do not need closing. The decision depends on your stroke history, age, other risk factors and the PFO’s features. Closure lowers the chance of another PFO-related stroke in selected patients; it cannot prevent every type of stroke.
Sources: [2]
What happens during treatment?
- Preparation: the hospital explains the anaesthetic, imaging and medicine plan. Local anaesthetic with sedation or a general anaesthetic may be used.
- Device placement: a catheter is passed from a groin vein to the heart. A small device is positioned across the PFO under imaging guidance.
- Closure: the device stays in place as heart tissue grows over it. The catheter is removed, and the groin and heart rhythm are monitored.
Recovery & medicines
Many people go home the same day or after an overnight stay. Arrange transport and support at home. Mild groin bruising can occur. Follow your discharge instructions on wound care, lifting, exercise, work and driving; restrictions related to your stroke may still apply.
Take your prescribed blood-thinning medicines for the agreed duration. Antiplatelet tablets are often used while the device heals. Some people need a different plan. Do not stop or change treatment without checking with your team.
Attend follow-up and any repeat heart scans. Report new or persistent palpitations, as an irregular rhythm such as atrial fibrillation can occur after closure. Tell your dentist about the device and ask the team about dental precautions.
Risks & alternatives
Risks include bleeding or injury at the groin, a new irregular heart rhythm, a clot on the device, device movement, and a remaining leak. Less common but serious complications include damage to the heart, stroke, emergency surgery and death.
An alternative is medical stroke prevention without closure. Depending on the cause of the stroke, this may involve antiplatelet or anticoagulant medicines and treatment of blood pressure, cholesterol and other risk factors. These measures can still be needed after closure.
Common questions
Does a PFO always need treatment?
No. Most are harmless and found incidentally. A PFO alone is not a reason to have a closure procedure.
Will closure stop every future stroke?
No. Closure addresses one possible route for a clot. Other causes of stroke remain possible, so ongoing prevention and follow-up matter.
Can it treat migraine?
PFO closure is not a routine treatment for migraine. Evidence and suitability differ from closure after a PFO-related stroke; specialist advice is needed.
When to get help
Call 999 for severe or persistent chest pain, severe breathlessness, collapse or signs of a stroke: face drooping, arm weakness or speech difficulty, even if they improve. A newly cold, pale or numb arm or leg on the catheter side also needs emergency help. For heavy or persistent wound bleeding, lie down, apply firm pressure and call 999. Do not drive yourself to A&E.
Contact your treating team promptly for fever, worsening wound redness or swelling, new palpitations or increasing breathlessness. If you cannot reach them, contact NHS 111. Do not wait for a routine private appointment.
Sources & further reading
- Leeds Teaching Hospitals: PFO closure in adults
- NHS England: PFO closure for prevention of recurrent stroke (PDF)
- Oxford University Hospitals: discharge advice after PFO closure (PDF)
- NICE: PFO closure for migraine
- Liverpool Heart and Chest Hospital: PFO closure
This general guide supports discussion with your care team. It does not replace your individual assessment, consent discussion or hospital discharge instructions. Hospital protocols and recovery times vary.
Discuss your next step
Dr Faisal Khan offers general and specialist cardiology consultations in London and Surrey. Bring your questions, medicines list and any relevant test results. If a procedure is appropriate, the team will confirm the treatment location and arrangements.
Arrange a consultation