PFO/ASD closure
Overview
A PFO (Patent Foramen Ovale) and an ASD (Atrial Septal Defect) is where there is a hole in the septum between the right and left atria.
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PFO is a flap which tends to close after birth, although remains patent in ~25% of the population, however for the majority of patients with PFOs there is no clinical significance.
-Foramen ovale is patent during fetal devlopment in order for blood to bypass non functional fetal lungs
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An ASD is a congeintal abnormality of the septum. This allows for blood to flow from the left to right atria or vice versa, resulting in mixing of arterial and venous blood (shunt).
-A right to left shunt is considered more severe as it results in de-oxygenated blood being pumped throughtout the body.
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If there is significant strain on the heart, the PFO or ASD may need to be closed.
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This can be done using TOE with x-ray, where a catheter is passed from the right atrium to the left atrium, and a closure device is deployed to expand and straddle both sides of the hole.​​
Procedure
​​Equipment
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Venous sheaths - usually starts with 7F which can be upgraded to delivery system sheath size
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Amplatzer catheter
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Septal occluder/ASD closure device (nitinol wire mesh filled wth Dacron fabric)
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sizing balloon may be used
​​Procedure
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Done under GA
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Venous access and catheter is inserted into RA (pressure sample recorded)
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Catheter crosses into the LA (pressure sample recorded)
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A sizing balloon catheter may be used to measure size of hole (this may be done on TOE too)
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An appropriate sized device is chosen, prepped and deployed across the septum.
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Successful device deployment is confirmed by TOE (colour doppler) and contrast/bubble injections
