Cardiac and Peripheral Procedures

Specialist services available: Advanced Cardiac Procedures and Interventions

• Alcohol Septal Ablation
• ASD/PFO Closure
• Coronary Flow wire / Functional Flow Reserve
• Left Atrial Appendage Closure
• Valvuloplasty

How is a PFO/ASD closed?

A patent foramen ovale (PFO) is typically closed with a minimally invasive, nonsurgical procedure during which a PFO closure device is implanted into the heart. This is generally performed under local anaesthesia and sedation in a Cardiac Catheter Laboratory. Much safer than open-heart surgery, this procedure produces little discomfort and patients are generally able to leave the hospital the next day. Most types of PFO closure devices consist of two anchors joined together. Starting with a catheter (a small, hollow tube) inserted into the femoral vein near the groin, the device is guided through this vein into the heart. Once in the heart and the hole located, the anchors are deployed on either side of the septal wall, closing the PFO. An atrial septal defect (ASD) is closed in a similar fashion. The size of the ASD must be carefully assessed and then closed using a very similar device to close the septum.

The device then adjusts to the unique anatomy of the heart. Soon after the device is implanted, tissue begins to form and eventually covers the PFO/ASD closure device completely. Endothelialisation, or the process of tissue formation, is important because it helps prevent blood in the left atrium from reacting with the exposed device and forming clots (called thrombosis).

Transcatheter closure of the PFO/ASD is a safe and effective procedure.

Follow the Sharpe Cardiology – Youtube Channel links here or at the bottom of the page to watch an actual PFO closure being performed.

Pre Procedure

Ensure your teeth are in good condition. This may involve a trip to the dentist. Post procedure avoidance of “dirty” procedures is advised for 6 months. Continue all blood thinners for the procedure. Take all medications on the day of procedure although diabetics should not take their diabetic tablets and only take half the usual insulin dosage.

Expectations After Discharge

You can commence exercise with walking on discharge. There should be no heavy lifting or straining for one month. Resumption of full activities can occur at one month. Patients having their PFO/ASD closed for the indication of Migraine can expect an increase in symptoms immediately post procedure before subsiding over the next few weeks. Patients in sedentary occupations can return to work day 2 but those in manual occupations will need specific advice. You must continue the blood thinners (often just aspirin) until advised to stop . In general terms this is a minimum of 1 year in Migraine patients and lifelong for stroke patients.

You will have a follow up echo pre-discharge and at 1 month with consultation and a 3 month TCDI to confirm closure prior to your consultation with Dr Sharpe. As well, migraine patients will be asked to fill out the MIDAS (migraine disability assessment) form again. Divers are generally permitted to return to full diving duties after the 3 month review.

Please avoid dental procedures for the first 6 months. If it is necessary before then and it is significant dental procedure then your dentist will give you antibiotics. It is not necessary for future dirty procedures that this is done.

Go to the FAQ – forms section of the website to print your discharge instructions

Left Atrial Appendage Closure

Atrial fibrillation (AF or AFib) is the most common irregular heart rhythm that starts in the atria. Instead of the SA node (sinus node) directing the electrical rhythm, many different impulses rapidly fire at once, causing a very fast, chaotic rhythm in the atria. Because the electrical impulses are so fast and chaotic, the atria cannot contract and/or squeeze blood effectively into the ventricle. The most common place for blood clots to form in heart is in the appendage of the left atrium. The atrial appendage is a piece of redundant tissue that is prone to clots forming. In patients that are intolerant to traditional blood thinning drugs such as Warfarin or the newer drugs such as Xaralto/ Pradaxa left atrial appendage closure may be an option.

The procedure involves placing wires and catheters through the femoral vein making a small hole in the atrial septum (membrane between the two top chambers of the heart) and blocking off/plugging the appendage with a stent like device. Dr Sharpe is one of a small group of interventional cardiologists qualified to perform this procedure in Australia.