PFO and ASD Closure
Dr Dawkins performs this procedure at Cleveland Clinic London and at the John Radcliffe Hospital in Oxford, where he is Clinical Lead for Structural Intervention.
PFO and ASD closure is a minimally invasive procedure to close a hole between the heart’s upper chambers, using a small device passed up through a vein in the groin. It is a major part of Dr Dawkins’s practice. For background on the conditions themselves, see patent foramen ovale (PFO) and atrial septal defect (ASD).
When do ASDs and PFOs need to be closed?
ASDs usually need to be closed as they are associated with enlargement of the right side of the heart which can cause breathlessness if left untreated. PFOs are very common and most do not need to be closed. The usual reason to offer PFO closure is for patients who have had a stroke where we feel it is likely that it was caused by the PFO. Where it would help, Dr Dawkins can arrange for you to see a neurologist to look at whether the PFO is likely to have caused the stroke and whether closing it is the right step.
PFO closure for divers and migraine
In scuba divers, a PFO can increase the risk of decompression illness. PFO closure may be recommended for professional divers, and keen amateur divers for whom diving is a major part of their life may choose to have their PFO closed. Dr Dawkins is very happy to discuss this with divers who are considering it.
Some people with migraine, particularly migraine with aura, have a PFO. Trials of PFO closure for migraine have had mixed results, and closure is not a routine treatment for migraine, but Dr Dawkins is happy to discuss whether it may be appropriate in individual cases.
How do you close ASDs and PFOs?
Most can be treated with a minimally invasive procedure avoiding open-heart surgery. The procedure is usually carried out as a day case, coming to hospital in the morning and generally going home the same day.
There are various different types of closure device, but most look like two interconnected umbrellas that are opened on either side of the hole and then pulled together to seal it. The device is delivered through one of the veins in the groin. The procedure is carried out with x-ray and ultrasound guidance. The ultrasound guidance uses either a transoesophageal echocardiogram (TOE), which is an ultrasound probe passed down the oesophagus into the stomach and is done under general anaesthetic, or intracardiac echo (ICE). Intracardiac echo is a small ultrasound probe that is advanced into the heart from one of the veins in the groin. This is generally done under local anaesthetic.
At the beginning of the procedure we would generally do a confirmatory bubble study to confirm that there is a hole in the heart. We will then use a very soft balloon to determine the size and shape of the ASD or PFO. We can then select the appropriate sized device. The procedure takes around 30 minutes.
If you would like to know more, Dr Dawkins and his team recorded a procedure from start to finish:
Recovery and follow-up
Most patients go home the same day. You should avoid heavy lifting and strenuous exercise for about a week. People generally take a few days off work and can then get back to their normal routine. You will need to take blood-thinning tablets for a period after the procedure, and we will explain exactly what to take and for how long. A follow-up echocardiogram checks that the device is well seated and the hole is sealed.
What are the risks of ASD or PFO closure?
The procedure is generally a low-risk procedure and the chance of a serious complication is very small. We will discuss the specific risks that relate to you at the time of your consultation.
What experience does Dr Dawkins have of ASD and PFO closure?
Dr Dawkins is Clinical Lead for Structural Intervention at the John Radcliffe Hospital in Oxford, where he leads the PFO and ASD closure service. PFO and ASD closure is a large part of his practice, both in Oxford and at Cleveland Clinic London, and he is often asked for a second opinion on whether PFO closure is the right choice.