Percutaneous closure of patent foramen ovale to prevent recurrent cerebral embolic events

3 The procedure

3.1 Percutaneous closure of patent foramen ovale has been introduced as an option for patients who have had a cerebral embolic event (such as stroke or transient ischaemic attack) and in whom paradoxical embolism through patent foramen ovale is considered to be the cause. It provides an alternative to surgical closure, which is typically considered for patients in whom medical management has failed or for patients in whom anticoagulant or antiplatelet therapy are contraindicated.

3.2 Percutaneous closure is performed using local anaesthesia and intravenous sedation, or with the patient under general anaesthesia. A closure device is introduced using a guide wire and delivery sheath through a small incision in the groin into the femoral vein. It is then passed into the heart and across the patent foramen ovale. The closure device is released to close the defect using image guidance such as echocardiography. Devices of differing design and mechanism are available.