Hole in the heart repair (ASD / PFO closure)

What is a hole in the heart repair (ASD / PFO closure)?

There are two common holes between the upper chambers of the heart. A patent foramen ovale (PFO) is a small flap-like opening that everyone has before birth and that stays open in around one in four adults. An atrial septal defect (ASD) is a true hole in the wall between the chambers and is usually larger.

Most PFOs cause no problems and need no treatment. PFO closure is mainly considered for younger adults who have had a stroke with no other clear cause, where tests suggest the PFO was the likely route for a clot. An ASD may be closed if it is large enough to strain the heart and lungs, causing breathlessness, palpitations or, over time, lung pressure problems.

Most holes are closed with a keyhole (transcatheter) procedure: a small umbrella-like device is passed up from a vein in the groin and opened across the hole, and tissue grows over it during the following months. Some ASDs, depending on size or position, are better closed with open-heart surgery.

Closing the hole can reduce the risk of another stroke in carefully selected people, or ease the strain of a significant ASD. It is not a treatment for everyone with a hole, and the decision usually involves detailed heart imaging and, for stroke cases, a joint discussion between heart and stroke specialists.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Keyhole closure vs open surgery

Suitability depends on the hole's size and position. Your cardiologist and surgeon will advise which is safer for you.

Preparing for your procedure

• Understand why closure is being recommended; for a PFO after stroke this should follow a joint heart and stroke specialist discussion.
• Expect detailed heart imaging beforehand, often including an ultrasound probe passed down the gullet (transoesophageal echo).
• Tell the team about all medicines, especially blood thinners and antiplatelets, and any allergies including to contrast dye.
• You may be asked not to eat for a few hours, particularly if a general anaesthetic is planned.
• Arrange a lift home and someone to stay with you, especially after sedation or a general anaesthetic.
• Plan light duties for about a week and avoid heavy lifting that could disturb the groin site.
• Ask which device will be used and what blood-thinning or antiplatelet medicines you will need afterwards.
• Discuss any antibiotic advice for dental work in the months after the device is placed.

What happens

Keyhole closure is done in a catheter lab. You will have local anaesthetic at the groin and usually sedation, or a general anaesthetic, sometimes guided by an ultrasound probe passed down the gullet to see the hole clearly.

The cardiologist passes a thin tube from a vein in the groin up to the right side of the heart and across the hole. A collapsed umbrella-shaped device is pushed through the tube and opened so that one disc sits on each side of the wall, gripping it and sealing the hole. Once the position is confirmed, the device is released and the tube removed.

The procedure usually takes about one to two hours. Afterwards, pressure is applied to the groin and you rest flat for a few hours. Most people go home the same day or the next morning.

If open surgery is needed instead, the hole is stitched or patched on a heart-lung bypass machine through a chest incision, which means a longer stay and recovery.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

Keyhole closure has a low overall risk, with major in-hospital complications reported at under about 1 in 100 in NHS information, and a risk of death of roughly 1 in 1,000. A device coming loose at or soon after implant is uncommon (around 1 in 100 in one NHS centre's figures) and may need retrieval. A recognised issue is a higher chance of a temporary irregular rhythm (atrial fibrillation or flutter) around the procedure. Ask your cardiologist about your own risk, the device being used, and how long you will need blood-thinning or antiplatelet medicines.

Published figures to discuss

Risks and benefits depend on why the hole is being closed, the hole's size and position, the device used and your overall health. The figures below are cautious examples from NHS sources for keyhole closure and are not a personal prediction; open surgery carries different, generally higher, risks.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

After keyhole closure most people are home within a day and back to light activity within about a week, but the device only fully heals in over several months as tissue grows across it.

• Bruising and tenderness at the groin that fades over a week or two
• Occasional palpitations or skipped beats in the early weeks
• Mild chest awareness as the device settles and heals in
• Tiredness for a few days after the procedure

Aftercare

• Rest and avoid heavy lifting, straining and vigorous exercise for several days to protect the groin.
• Keep the groin site clean and dry and watch for swelling, bleeding or a painful lump.
• Take blood-thinning or antiplatelet medicines exactly as advised, and do not stop them on your own.
• Ask about antibiotic cover for dental and some other procedures while the device heals in.
• Do not drive for a couple of days and as your team advises.
• Build activity back up gradually and drink enough fluids.
• Attend follow-up imaging so the device and seal can be checked.

• Lift home arranged and someone to stay overnight
• Loose clothing that does not press on the groin
• Blood-thinning or antiplatelet medicines organised as advised
• Dental/antibiotic advice noted for the healing-in period
• Time off planned (about a week) and driving paused for a couple of days
• Follow-up echocardiogram appointment booked
• Clinic's contact number saved for groin or rhythm worries

Scars and how they heal

There is usually no chest scar with keyhole closure; the device goes in through a small puncture in the groin that heals as a tiny mark, with bruising that settles over a week or two. If open surgery is needed instead, there will be a chest scar that fades over months.

⚠ Get urgent help if…

• Signs of stroke: face drooping, arm weakness or slurred speech — call 999
• Sudden severe chest pain, fainting or a very fast or irregular pulse that does not settle
• New breathlessness that is getting worse
• A swelling, painful lump, fresh bleeding or coldness/numbness in the leg at the groin site
• A high temperature or feeling generally unwell
• Palpitations that are persistent or distressing
• Severe chest discomfort when breathing in (possible fluid around the heart)

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is the hole sealed by the device, confirmed on an echocardiogram, with the device well seated as tissue grows over it. In carefully selected younger adults who have had an unexplained stroke, PFO closure can reduce the risk of another stroke compared with medicines alone. For a significant ASD, closure can reduce strain on the heart and lungs and ease symptoms.

Closure does not undo damage already done and does not remove every future risk. It can slightly increase the chance of a temporary irregular rhythm around the procedure. For stroke prevention, closure is one part of a wider plan that includes managing other risk factors. Results and suitability depend heavily on careful selection and imaging.

Once the device has healed in, the closure is generally permanent and devices are designed to stay in place for life. Late problems are uncommon but can include rare erosion of the device or new irregular rhythms, which is why follow-up imaging and reporting symptoms matter. For PFO closure after stroke, the long-term benefit depends on careful patient selection and on continuing to manage other stroke risk factors.

Related tests, treatments or support

Hole closure is usually planned alongside a wider stroke-prevention or heart plan, including blood-thinning or antiplatelet medicines and managing risk factors such as blood pressure. People with an ASD may also need their rhythm checked, as atrial fibrillation can occur with longstanding holes. Your cardiologist will explain how closure fits with the rest of your care.

Follow-up & long-term care

You will usually have an echocardiogram in the months after closure to confirm the hole is sealed and the device is well seated, with longer-term review as advised. Medicines are reviewed at these visits, and antibiotic advice for dental work is given for the healing-in period. Report stroke symptoms, persistent palpitations or groin problems without waiting.

• Take blood-thinning or antiplatelet medicines for the advised period while the device heals in.
• Follow any advice on antibiotic cover for dental and some other procedures during healing.
• Attend follow-up echocardiograms to confirm the seal and device position.
• Keep managing stroke and heart risk factors such as blood pressure and an irregular rhythm.
• Report new palpitations, breathlessness or stroke symptoms promptly.

Repeat, follow-on and what comes next

• A device that does not seat well may need repositioning or retrieval, occasionally by surgery.
• A small leak across the hole can persist and is checked on follow-up imaging.
• Late problems such as device erosion are rare but are a reason for follow-up.
• Open surgical repair is the fallback when a device is not suitable.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Clear groin-care instructions and a named contact for bleeding, rhythm or stroke symptoms.
• A written plan for blood-thinning or antiplatelet medicines and how long to take them.
• Antibiotic advice for dental and some other procedures during the healing-in period.
• A follow-up echocardiogram to confirm the seal and device position.
• Ongoing management of stroke and heart risk factors as part of the wider plan.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether keyhole closure or open surgery is needed (open surgery costs more and means a longer stay)
• The cardiologist's (operator's) or surgeon's fee and the catheter-lab or theatre and facility fees
• The occluder device and its size
• Whether sedation or a general anaesthetic and an anaesthetist are used, plus any gullet ultrasound
• Length of stay
• Pre-procedure imaging and follow-up echocardiograms
• The cost of managing a complication if one occurs

• The operator's or surgeon's fee and the catheter-lab/theatre and facility fee
• The cost of the closure device
• Sedation, anaesthetist and any gullet-ultrasound fees
• Overnight or inpatient stay if needed
• Pre-procedure imaging and follow-up echocardiograms
• What happens, and what is charged, if the device needs repositioning or a complication occurs
• The cancellation policy

On the NHS? Closure is available on the NHS for specific reasons, such as PFO closure for stroke prevention in people aged 60 or under after specialist assessment, or significant ASDs; private care is generally for speed or choice.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the surgeon is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Why do you think my hole needs closing, and what happens if I leave it?
• For a PFO after stroke, has this been discussed jointly by heart and stroke specialists?
• Is a keyhole device or open surgery safer for the size and position of my hole?
• What are my personal risks, including device problems and irregular rhythms?
• Which blood-thinning or antiplatelet medicines will I need, and for how long?
• What follow-up imaging will I have, and what antibiotic advice applies for dental work?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this procedure not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for hole in the heart repair (asd / pfo closure)

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS (Liverpool Heart and Chest) — PFO and ASD closure NHS (Leeds) — Atrial septal defect: percutaneous (keyhole) closure British Heart Foundation — Atrial septal defect (ASD) British Heart Foundation — PFO: a harmless heart hole? Transcatheter closure of ASD: review of currently used devices — PMC PFO closure vs medical therapy for cryptogenic stroke (meta-analysis) — PMC

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.