Learning About Patent Foramen Ovale Transcatheter Repair in Children

A patent foramen ovale (say "PAY-tunt fuh-RAY-men oh-VAL-ee") transcatheter repair is a procedure that closes a small opening in the heart's septum. This is the part that separates the upper right and left chambers (atria) of the heart. The opening, the foramen ovale, normally closes after birth. But sometimes it stays open, allowing a little blood to flow between the atria. This is called a patent foramen ovale, or PFO.

A PFO usually doesn't cause problems as a person gets older. But sometimes it can lead to problems such as a stroke. This can happen if a blood clot moves out of the heart and travels to the brain.

A PFO closure may help lower your child’s risk of a stroke in the future. A device is used to close the opening so that blood and blood clots don't flow through the opening anymore.

Your child may have a cardiac catheterization procedure.

Your child may be asleep for the procedure or may get a sedative to help relax. During the procedure, a doctor inserts a long, flexible tube called a catheter into a blood vessel in the groin. The doctor guides it to the PFO. A device that can plug up the PFO is attached to the end of the catheter. When the device is in place, the catheter is removed from the body. The insertion site is closed, and a bandage is put on it.

The repair takes about 2 hours. Your child may spend the night in the hospital, or they may go home the same day.

• Your child may need to lie flat for a few hours after the procedure without bending their legs. This helps prevent bleeding.
• For 1 or 2 days, keep a bandage over the spot where the catheter was inserted. The bandage probably will fall off in this time.
• Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your child’s skin.
• Your child may shower 24 to 48 hours after the procedure, if the doctor okays it. Pat the incision dry.
• Don't soak the catheter site until it's healed. Don't let your child take a bath or swim for 1 week, or until the doctor tells you it's okay.
• Your child may go back to normal activities after at least 1 week. Don’t let them do any strenuous activities or heavy lifting until the doctor says it’s okay.
• Ask what medicine your child needs to take. They may need to take antibiotics or medicines for a while to prevent blood clots. Give pain medicine as directed. If the doctor prescribed antibiotics for your child, give them as directed. Do not stop using them just because your child feels better. Your child needs to take the full course of antibiotics.
• Contact your doctor if you think your child is having a problem with a medicine. You'll get more details on the medicines your doctor prescribes.

• Your child may need follow-up tests, like an echocardiogram or an electrocardiogram.
• For 6 months after your child has the PFO closure, be sure to tell all of your child’s doctors and their dentist that they have the device in their heart. This is important. Your child may need to take antibiotics before some procedures to prevent infection.
• Within the coming year, your child will likely have follow-up tests to check that the device has closed off the PFO.

Call 911 anytime you think your child may need emergency care. For example, call if:

• Your child passes out (loses consciousness).
• Your child has symptoms of a stroke. These may include:
  • Sudden numbness, tingling, weakness, or loss of movement in the face, arm, or leg, especially on only one side of the body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.
• Your child’s heartbeat feels very fast, skips beats, or flutters.
• Your child has bleeding from the area where the catheter was put in the blood vessel, and it cannot be stopped with direct pressure.
• Your child has a fast-growing, painful lump at the catheter site.
• Your child’s leg is painful, cold, tingly, or numb or looks pale, bluish, or purplish.
• Your child has new or worse trouble breathing.

Contact your doctor now or seek immediate medical care if:

• Your child has bleeding from the area where the catheter was put in the blood vessel, and it can be stopped with direct pressure.
• Your child has symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the catheter site.
  • Pus draining from the catheter site.
  • A fever.

Watch closely for changes in your child’s health, and be sure to contact the doctor if your child has any problems.