Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defect

The symptoms of a Patent Foramen Ovale or atrial septal defect may be managed by medications. In some cases, surgery may be needed.

The heart has four chambers, the upper two called atria and the lower two called ventricles. The left and right atria are separated by a partition called the interatrial septum. This prevents the mixing of oxygenated blood in the left atrium with the deoxygenated blood in the right atrium. 

After a baby is born, generally, there is no communication between the two atria. Thus, the blood from the two sides of the heart is not mixed. In rare cases, there can be defects or holes in the septum between the atria. These holes can be of two types:

1. Atrial Septal Defect (ASD): ASD occurs when the septum wall does not grow completely before a baby is born. ASD can be of different sizes and the larger the defect, the more likely it is to cause problems.
2. Patent Foramen Ovale (PFO): As the name suggests, a patent foramen ovale happens when the normal hole in the wall between the left and right atria (foramen ovale) of a fetus fails to close after the birth. Foramen ovale is important in the fetus as it allows blood to bypass the fetal lungs, which cannot work until they are exposed to air. When a baby takes its first breath after its born, the foramen ovale closes, and within a few months, it seals completely in about 75% of babies. A PFO is generally smaller than an ASD, the symptoms in a person with a PFO may not be as obvious as in an ASD. In much of the people, a PFO does not cause any problem, even though blood mixes between the right and the left atrium. Problems, however, can occur when that blood contains a blood clot.

The symptoms of a Patent Foramen Ovale or atrial septal defect may be managed by medications. In some cases, surgery may be needed. 

Options for surgical closure include open-heart surgery and percutaneous (through the skin) closure. 

• Percutaneous closure is a common surgery to treat patients with a patent foramen ovale (PFO) and atrial septal defect (ASD). 
• The surgery is done with the help of a special closure device. 
• The percutaneous closure procedures are monitored using an X-ray and an ultrasound camera inserted in the heart from a leg vein.
• The device is folded or attached on to a special flexible long tube (catheter). 
• The catheter can be inserted into a vein in the leg or groin and advanced into the heart and through the defect (ASD or PFO).
• The device is then gradually pushed out of the catheter allowing each side of the device to open up and cover each side of the hole in a way that the hole is sandwiched between the two opened parts of the device. This closes the hole or defect (ASD or PFO) and establishes a partition between the left and right atria. 
• Once the device is in a proper position, it is detached from the catheter. 
• As the heart tissue grows over the implant over time, the implant becomes a part of the heart.

The complications of the procedure include:

• Bleeding
• Infections
• Embolism (a traveling blood clot that is formed at one site and lodges at another site in the body)
• Cardiac tamponade (compression of the heart by fluid accumulated around it)
• Loss of device
• Incomplete closure of the defect
• Air embolism (air bubbles trapped inside the blood vessels that may travel with the blood and may cause blockage of a small blood vessel in the body)