PFO Closure – 3/11/2024

Today is the day, the long awaited and at the same time, dreaded day. Today is the day of my PFO Closure. I have been anxious about this surgical procedure since the day I was called to schedule. After weeks of sleepless nights and constant thoughts of what ifs, I find myself waking up to my 5:30 alarm. I had to be at the hospital at 7am for the 8am procedure. I feel like the entire morning was a sleepy blur. I stayed up the night prior until about midnight, finally researching the procedure. I watched a couple of videos on it and read some material I found online and talked to my sister about it some but never Indepth. I saw so much mixed information it made me feel crazy.

Blake and I left for the hospital around 7. I was allowed to drink clear liquids until 6am which was nice. I was able have some water before going to the hospital. We arrived at the hospital and somehow found a parking spot on the top floor of the parking garage. We get inside the hospital and go through metal detectors and head upstairs to see where we needed to go. We made our way to the elevators and up to the 3rd floor. I wasn’t positive we were where we needed to be, so I asked the registration desk and sure enough, we were right where we needed to be. I get registered, put on my hospital and I am handed papers for the nurse. We have a seat and within a couple of minutes, I was called back.

Back in the room, the nurse takes my vital signs and I have to pee in a cup to check for pregnancy. I joked that it would be a miracle if I was pregnant since I had a hysterectomy 2 years ago (at the same hospital). I was thrown off by the test, and the results were negative. I get changed into my hospital gown and put on my green hospital socks and lay in the bed. I tell the nurse that I am a hard stick when she went to start the IV. She checked both of my arms and then went to grab the Vein finder. The Vein finder worked, and she got my IV started and began fluids. The nurse asked the standard questions, name/DOB, do you know what procedure you are having, etc. She wanted to know if I knew the ins and outs of the procedure, I told her I had some knowledge but not a lot. She explained a little bit about the procedure and next thing I know, she is wheeling me back to a room in the OR. I waited in a little bit in this room before I went to the procedure room. I met with a Cardiology Fellow that would be assisting in the procedure. He explained a bit more of what would be going on during the procedure. I noticed a lot Radiation Protection Gowns outside of the procedure rooms and I was wondering what they were for.

Once inside the procedure room, I was given more details of what would be occurring. I was placed on the procedure table and given Heparin (Blood Thinner) and Cefazolin (conscious sedation). The sedation was only to relax me since I would be awake during the procedure.

Next came the numbing medication shots on both sides of my groin. OUCH!! These hurt and I immediately started crying. Now the procedure begins.

Procedure:

Access Site: right and left femoral veins with ultrasound guidance

Drains:

Venous Sheath 6 Fr. Right Femoral (Active)

Venous Sheath 8 Fr. Left Femoral (Active)

Peripheral IV 03/11/24 Anterior;Right Forearm (Active)

The procedure was done under ultrasound guided imaging, and I was able to watch the procedure on one of the monitors. I watched the wires go into my heart and I could see the device placement. Once the device was in place, I was able to see my heart beating with the device inside. It was such a wild experience. Once the wire was out, I had to have both catheters stitched in place before leaving the room. The stitches were placed in my legs, and it was quite painful.

Device:

Implant Name: Occluder Cribriform 25MM

Type: Cardiovascular Occluders

Manufacturer: Abbott (St. Jude Medical)

Once I got back to the recovery room, I had to have blood drawn to check my levels before the catheters could be removed. My numbers were great and both catheters were removed. 2 nurses had to hold pressure on both sites for 10 minutes due to the blood thinners. Once the catheters were out, Blake was able to come back into the room. It was nice that the procedure was over. I had to move rooms again, this time to a short stay recovery room where I was on bedrest for 4 hours. I had to lay on my back with no more than a 30-degree angle. This was miserable. Prior to leaving the procedure room, I was given a medication to reverse the sedation. Knowing I had to have 4 hours of bedrest, I wish they would have kept the sedation going so I could relax and get some sleep but all I could think about the entire 4 hours was having to go to the bathroom. I was told I could use the PureWick but that is not something I am able to use. It is in my head or something, but I have never been able to use one, so I just waited out the 4 hours.

I had 2 nurses (1 was training) that worked with me during my 4 hours of bedrest. for the first 2 hours, I was checked on every 15 minutes. My Blood pressure was checked and so were my incision site. Hour 3 was every 30 minutes and then once more before I could get up (and go to the bathroom). I was allowed to order food from the hospital cafeteria that had to be heart healthy. Hospital food is always a hit or miss so Blake went to go get some food from the food trucks that are around the hospital during lunch. Blake got himself a sandwich and I got a chicken quesadilla, rice and plantains. Both were delicious. I will say, it was weird to eat laying down.

After the 4 hours of the bedrest, I was able to get up, change and get ready to leave the hospital. I was given the discharge paperwork, and the instructions were explained to me in detail.

Instructions:

PFO CLOSURE
You have undergone placement of a closure device for your patent foramen ovale (PFO).

Following your cardiac procedure, seek immediate medical attention/call 911 for any of the following:
-You experience sudden onset shortness of breath
-You have significant bleeding from your surgical/procedure site. Apply direct pressure to the procedure site if this
occurs.
-You experience sudden change in mental status, confusion, have trouble walking or talking.
-You have significant lower abdominal pain, fullness, back or flank pain, or abdominal soreness after your procedure
involving femoral access.

Following your procedure call the Cardiovascular Procedure Care Unit

ask to page the cardiology interventional fellow
on call for any of the following:
-If you have questions about your cardiac procedure
-If you experience chest pain
-If you have questions about ongoing discomfort or swelling at the procedure site or the affected leg.
-If you have signs or symptoms of infection such as fever over 100.4, redness, increased swelling, or drainage at the
procedure site.
-Have increased pain or swelling of the affected leg.
-If you are unable to fill a prescription for medication that has been prescribed following your procedure.

Post-Procedure Activity Restrictions
-No lifting over 10 pounds for 2 days following your procedure.
-No lifting over 40 pounds or contact sports for 3 months after placement of your PFO closure device.
-To avoid straining with bowel movements, you may use a stool softener such as Colace.
-No driving for 48 hours after your procedure.
-Have someone stay with you until the effects of the sedation you have received have worn off.
-You may shower the day following your procedure.
-No tub baths for 48 hours following your procedure.

Post Procedure Medication Instructions
-Resume all of your medications as taken prior to admission
-If you are unable to fill a medication that has been prescribed following your procedure, call your primary cardiologist.
-Continue aspirin 81 mg daily for a minimum of 6 months following your procedure.
-You will be prescribed PLAVIX (clopidogrel) 75 mg daily for a minimum of 3 months following your PFO closure. Do
not stop taking this unless instructed to do so by your cardiology provider.
-Plavix (clopidogrel) is an antiplatelet medication.
-Please tell any health care providers caring for you that you are taking this medication.
-Call your health care provider if you notice unusual bruising, bleeding, or rash.

Bacterial Endocarditis Prophylaxis
-You are advised to take antibiotics for bacterial endocarditis prophylaxis in advance of certain dental and medical
procedures for 6 months following placement of your device.

The part about the dentist, I sort of knew already. During my last dental cleaning, I the possibility of the PFO closure was discussed and my Dentist told me to ensure that for 6 months following the procedure, I alert them and I would need to be given antibiotics prior. The nurse in the recovery room, explained to Blake and me why. The nerves in the jaw area go down to the heart and can cause infection. This was interesting to us, especially Blake, he knows a lot of Jeopardy answers.

Once we were able to leave, we left and did not look back. It was nice to be out of there and get home and be well on my way to recovery. My 4 older kids are with their dad this week and I know my girls were really worried about me. I was able to text their awesome teachers to let them know that I was done, and everything went well. They were happy to pass the message on for me. Their dad let the call me this evening to talk to me. Taylor stayed the night at her Bama’s house and once she woke up from her nap, Blake went over to get her, and she was happy to have me back home and wanted to help take care of me. The rest of the evening, well, that was resting.

I am hoping this is the last of big procedures related to stroke. I am having to do follow ups with my Cardiologist 30 at the end of the month and I also have to have a repeat Echo with Bubble Study to ensure the device is staying in place and working the way it should. Both of these appointments have been scheduled. I am looking forward to next week when I am pretty much back to myself and get to do normal things with very few limitations.

I want to thank all of the Doctors, Nurses and Staff at VCU that took such good care of me during my surgery!

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