The foramen ovale is an early heart valve that closes and fuses after birth in most people (> 90%). In people with a patent foramen ovale, thrombi from the venous system can, in rare cases, enter the systemic circulation via this pathway and cause strokes, for example.
In patients and female patients who suffer a stroke at an early age (< 65 years) and in whom no cause other than patent foramen ovale has been demonstrated (cryptogenic stroke), closure of the foramen ovale should be performed.
The following preparatory examinations are necessary: Computed tomography or magnetic resonance imaging of the brain, ultrasound examination of the neck arteries (carotid Doppler), long-term ECG, cardiac ultrasound via the esophagus (transesophageal echocardiography).
The standard method is closure with an occluder. The procedure is performed under local anesthesia; general anesthesia is usually not necessary. The open foramen ovale is probed with a wire via the inguinal vein and then a catheter system is placed in the atrium of the left heart. The occluder consists of two closely spaced self-expanding umbrellas connected by a bar. The occluder is advanced through the catheter system, the first umbrella is deployed in the left atrium and pulled to the atrial septum, the second umbrella is then deployed on the right atrial side. The foramen ovale is covered and closed by the umbrellas. The catheter system is then removed and the puncture site in the leg vein is sutured. The procedure takes about 15-30 minutes.
Alternatively, in anatomically suitable cases, the patent foramen ovale can be closed with a special suture system (Noblestitch) and without implantation of an occluder. The procedure is also performed under local anesthesia and takes approximately 30-60 minutes.
After the intervention, monitoring is necessary for at least six hours, and bed rest with a pressure dressing should be maintained for approximately three hours. In total, an inpatient stay of at least one to two nights must be expected.