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Specialist services available:-

Advanced cardiac procedures and interventions

alcohol septal ablation ASD/PFO closure coronary flow wire/ functional flow reserve left atrial appendage closure valvuloplasty  

How is a PFO/ASD closed?

 A patent foramen ovale (PFO) is typically closed with a minimally invasive, nonsurgical procedure during which a PFO closure device is implanted into the heart. This is generally performed under local anaesthesia and sedation in a Cardiac Catheter Laboratory. Much safer than open-heart surgery, this procedure produces little discomfort and patients are generally able to leave the hospital the next day. Most types of PFO closure devices consist of two anchors joined together. Starting with a catheter (a small, hollow tube) inserted into the femoral vein near the groin, the device is guided through this vein into the heart. Once in the heart and the hole located, the anchors are deployed on either side of the septal wall, closing the PFO. An atrial septal defect (ASD) is closed in a similar fashion. The size of the ASD must be carefully assessed and then closed using a very similar device to close the septum. The device then adjusts to the unique anatomy of the heart. Soon after the device is implanted, tissue begins to form and eventually covers the PFO/ASD closure device completely. Endothelialisation, or the process of tissue formation, is important because it helps prevent blood in the left atrium from reacting with the exposed device and forming clots (called thrombosis). Transcatheter closure of the PFO/ASD is a safe and effective procedure. Follow the Sharpe Cardiology - Youtube Channel links here or at the bottom of the page to watch an actual PFO closure being performed.

Cryptogenic Stroke and PFO Evidence Update 

There have been 3 landmark studies published in the New England Journal of Medicine, 14th September 2017 which strongly support closure of the PFO in cryptogenic stroke over medical therapy. There was some evidence 5 years ago when the RESPECT study short-term follow up showed in the Per Protocol and Actual Treatment analysis significant p-values suggesting PFO closure was benifical. SOME OF THE DATA:

RESPECT: the 10-year Intention-to-Treat data has shown a risk reduction of secondary CVA of 62% (p=0.007) in the

Amplatzer (Abbott) device arm. No serious adverse event in device arm.

REDUCE: showed patients randomised to medical therapy had a 400% (p= 0.001) higher annualised risk of

recurrent stroke versus the closure Cardioform (GORE) arm.

CLOSE: had no strokes in the device arm compared to 14 strokes in the medical therapy arm. This study allowed

physician discretion in choosing the closure device.


Do not wait for the second stroke! “

Pre Procedure

Ensure your teeth are in good condition. This may involve a trip to the dentist. Post procedure avoidance of “dirty” procedures is advised for 6 months. Continue all blood thinners for the procedure. Take all medications on the day of procedure although diabetics should not take their diabetic tablets and only take half the usual insulin dosage.

Expectations after discharge

You can commence exercise with walking on discharge. There should be no heavy lifting or straining for one month. Resumption of full activities can occur at one month. Patients having their PFO/ASD closed for the indication of Migraine can expect an increase in symptoms immediately post procedure before subsiding over the next few weeks. Patients in sedentary occupations can return to work day 2 but those in manual occupations will need specific advice. You must continue the blood thinners (often just aspirin) until advised to stop . In general terms this is a minimum of 1 year in Migraine patients and lifelong for stroke patients. You will have a follow up echo pre-discharge and at 1 month with consultation and a 3 month TCDI to confirm closure prior to your consultation with Dr Sharpe. As well, migraine patients will be asked to fill out the MIDAS (migraine disability assessment) form again. Divers are generally permitted to return to full diving duties after the 3 month review. Please avoid dental procedures for the first 6 months. If it is necessary before then and it is significant dental procedure then your dentist will give you antibiotics. It is not necessary for future dirty procedures that this is done. GO THE FAQ- FORMS SECTION OF THE WEBSITE TO PRINT YOUR DISCHARGE INSTRUCTIONS