From the Guidelines
Post-PFO closure monitoring should prioritize antiplatelet therapy, regular echocardiography, and ECG checks to minimize the risk of complications and ensure proper device endothelialization, as supported by the latest guidelines and studies 1. The monitoring regimen typically involves antiplatelet therapy with aspirin 81-325 mg daily for 6 months and clopidogrel 75 mg daily for 1-3 months.
- Patients should undergo transthoracic echocardiography (TTE) with bubble study at 3-6 months post-procedure to confirm device position and assess for residual shunting.
- Additional follow-up includes an ECG at 1 month and 6 months to monitor for arrhythmias, particularly atrial fibrillation which can occur in 2-5% of patients, as reported in the CLOSE trial 1.
- Patients should be advised to take prophylactic antibiotics for dental procedures for 6 months after device placement to prevent endocarditis.
- Physical activity restrictions include avoiding strenuous exercise and heavy lifting (>10 pounds) for 1 week, and contact sports for 6 months.
- Patients should report symptoms like chest pain, palpitations, dizziness, or neurological symptoms immediately, as these may indicate complications such as device erosion, embolization, or persistent shunting. The latest guidelines from the Canadian stroke best practice recommendations support the use of PFO closure for carefully selected patients, and emphasize the importance of patient counseling and shared decision-making 1.
- The guidelines also highlight the need for careful patient selection, taking into account factors such as age, stroke severity, and the presence of other medical conditions.
- The RESPECT trial, which reported its extended follow-up results, found that PFO closure was associated with a reduced risk of recurrent ischemic stroke, particularly in patients with an atrial septal aneurysm or a "substantial" shunt size 1. However, the guidelines from the American Heart Association/American Stroke Association council on stroke, published in 2006, are less relevant to the current question, as they do not provide specific recommendations for post-PFO closure monitoring 1.
From the Research
PFO Closure Post-Procedure Monitoring
- The safety and efficacy of percutaneous closure of patent foramen ovale (PFO) under transthoracic echocardiography (TTE) guidance have been demonstrated in several studies 2, 3.
- A study of 52 consecutive patients who underwent percutaneous closure of PFO under TTE guidance showed a success rate of 90.4% and no severe complications at discharge 2.
- The median hospital stay was 3.0 days, and at a median follow-up of 15.5 months, there were no complications such as death, stroke, transient ischemic attack (TIA), or residual shunt 2.
- Another study of 139 patients who underwent transcatheter PFO closure under TTE guidance showed no neurologic or cardiovascular complications during the immediate and long-term follow-up period (2-67 months, median 29) 3.
- The use of TTE guidance during percutaneous closure of PFO has been shown to shorten the procedural time and obviate the need for general anesthesia or endotracheal intubation 3.
- Current guidelines recommend closure of PFO in patients with cryptogenic stroke or systemic embolization, and the latest evidence supports its superiority in reducing the risk of recurrent embolic stroke in patients with PFO-related stroke 4, 5.
- Post-procedure monitoring typically includes follow-up by TTE, electrocardiogram, and clinical evaluation at regular intervals to assess for complications and residual shunt 2, 3.