PFO Closure in Asymptomatic Pregnant Women

Key Evidence Against Routine Closure in Asymptomatic Patients

Asymptomatic individuals with PFO do not have an increased risk of stroke compared to the general population, as demonstrated in both the Northern Manhattan Study and the Olmsted County SPARC study, according to the American College of Cardiology 1
The longitudinal risk of stroke among asymptomatic subjects with PFO does not justify prophylactic intervention, as stated by the American College of Cardiology 1

Asymptomatic pregnant women with incidentally discovered PFO require no specific treatment or intervention, as recommended by the European Society of Cardiology 2
The European Society of Cardiology guidelines state that closure of a small ASD or persistent foramen ovale for the prevention of paradoxical emboli is not indicated 2
Pregnancy is generally well tolerated by women with PFO, and the only contraindication to pregnancy would be the presence of pulmonary arterial hypertension or Eisenmenger syndrome—not the PFO itself, according to the European Society of Cardiology 2
Prevention of venous stasis through use of compression stockings and avoiding the supine position is recommended by the European Society of Cardiology 2
Early ambulation after delivery should be encouraged, as suggested by the European Society of Cardiology 2
For prolonged bed rest situations, prophylactic heparin administration should be considered to prevent deep venous thrombosis, as recommended by the European Society of Cardiology 2
Diligent care to eliminate air in intravenous lines is important to prevent potential systemic embolization, according to the European Society of Cardiology 2

Device or procedure-related adverse events occur in 3.6% of cases, as reported in the BMJ 3, 4
Persistent atrial fibrillation occurs in 1.8% and transient atrial fibrillation in 1.2% of patients after closure, as reported in the BMJ 3, 4

Spontaneous vaginal delivery is appropriate for most cases, as recommended by the European Society of Cardiology 2
No special cardiac monitoring or cesarean delivery is required solely based on PFO presence, according to the European Society of Cardiology 2
Standard obstetric care with attention to preventing venous stasis is sufficient, as stated by the European Society of Cardiology 2