TREATMENTS
CLOSURE OF FOP (PERMEABLE FORAMEN OVALE)
Why are you being offered a closure of the FOP?
The foramen ovale is a passage in the septum separating the two atria of the heart present at the stage of embryonic life and which closes spontaneously shortly after birth. It can happen that this closure does not occur or re-opens (this is called a "permeable" foramen ovale) and is responsible for symptoms in adulthood, the most serious of which is stroke, a neurological complication requiring the closure of the PFO to prevent a recurrence.
Performing the closing gesture:
You will be fasting for a few hours before the procedure.
The procedure consists of the implantation of a prosthesis comprising 2 metal mesh discs connected by a small connection and which are positioned on each side of the partition between the 2 atria to make it waterproof. This flexible prosthesis is implanted by cardiac catheterization via a puncture of the femoral vein.
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This procedure is performed with ultrasound guidance (usually transthoracic or transesophageal), requiring general anesthesia or simple sedation.
In more than 80% of cases, the communication between the 2 atria disappears completely just after the implant of the prosthesis. In other cases, the closure will be effective in the following weeks.
You will be asked to lie down for a few hours after the procedure.
Your discharge will usually take place the day after the procedure after a transthoracic ultrasound check.
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What are the expected benefits?
In large studies, closure of the PFO combined with antiplatelet therapy reduces the risk of stroke recurrence by about 60% compared to antiaggregation therapy alone (usually low-dose aspirin).
What are the risks involved?
Despite the experience of the operators and the significant technical progress made in catheters and prostheses, it is an invasive procedure with risks:
• allergic complications, most often related to the use of anesthesia products.
• vascular complications at the femoral puncture site: the most common is a hematoma which results in a bluish appearance that is usually inconsequential and disappears after a few days. Rarely (<1% of cases) a vascular injury may require surgical repair or transfusion.
• cardiovascular complications during the hospital period: they are very rare (<0.5% of cases) of stroke, hemorrhagic effusion around the heart or displacement of the prosthesis, which may require additional intervention, sometimes surgery.
• cardiac complications after hospital discharge: the most common complication is the occurrence of palpitations related to a rhythm disorder (<5% of cases): generally early (first weeks) and transient, this arrhythmia may require additional surgery or treatment if it persists. Much rarer (<0.5% of cases),
Clots may form on the denture or displacement of the prosthesis.
• complications leading to death: these are very exceptional (<0.1%).
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What follow-up after the implant of the prosthesis?
The implantation of the prosthesis makes it necessary to take antiplatelet therapy for a minimum of 6 months.
No special physical or professional precautions are necessary after the implantation of the prosthesis. This prosthesis also does not contraindicate any future exploration or intervention.
Antibacterial prophylaxis will be offered in the event of high-risk extracardiac procedures during the 6 months following the implantation of the prosthesis.
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Ultrasound follow-up will be proposed to ensure the absence of significant residual communication between the 2 atria.
FOP closure prosthesis
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