NMT II: Understanding PFO Closure

What is a PFO?

A PFO is a relatively common heart defect characterized by an unsealed tunnel between the right and left atria of the heart. This defect has been known to be present in anywhere between 10%-25% of people. However, in a number of cases, it is benign.

HEART_PFOcombo2How does a PFO occur?

The PFO is formed as a trace of the fetal circulation. When the chambers of a human heart begin to develop, a tunnel is made between the right and left atria, allowing blood to flow directly from the venous circulation to the arterial circulation, circumventing the non-functioning fetal lungs. Following birth, the pressure differential between the right and left atria changes with newly operational blood flow to the fully functioning lungs. Because of this, the tunnel eventually closes completely within the first few months.  However, in some patients, the foramen ovale fails to seal and stays “patent”. In patients with a patent foramen ovale (PFO), the tunnel can reopen under elevated atrial pressure, such as coughing, or straining.

What are the effects of a PFO?

A key issue with PFO is that it gives a pathway for blood clots to pass directly to the arterial circulation without being filtered out by the capillary bed of the lungs. A PFO can also let deoxygenated blood and certain chemicals to cross over to the arterial side. The presence of a PFO has been linked to a number of clinical issues, mainly stokes and migraines. Developments are being made to solidify the link between PFO and strokes or migraines, and to identify patients that would benefit from PFO closure.

The NobleStitch is approved in Europe for vascular and cardiovascular suturing and PFO closure. In the United States the NobleStitch is FDA cleared and is indicated for use in the placement of sutures for soft tissue approximation in surgical procedures such as general, vascular and cardiovascular surgery, including endoscopic procedures at the end of that last sentence add The NobleStitch EL is not indicated for blind closure.

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