Antepartum Transcatheter Patent Foramen Ovale Closure During Pregnancy: A Risk-Based Clinical Perspective

Transcatheter closure of a patent foramen ovale (PFO) during pregnancy is generally not recommended, because of concerns regarding fetal safety, procedural radiation exposure, and a lack of robust evidence. Postpartum intervention therefore is usually preferred. Pregnancy itself is a hypercoagulable state, and a subset of pregnant patients with PFO may face an unacceptably high risk of recurrent embolic events after pregnancy recognition, despite optimized medical therapy. How such exceptional situations should be evaluated remains insufficiently defined.

This Statement/Opinion (SO) synthesizes current recommendations from the 2025 European Society of Cardiology guidelines on cardiovascular disease in pregnancy and the relevant literature, to propose a structured framework for decision-making regarding antepartum PFO closure. We focus on (1) rigorous maternal risk stratification, (2) multidisciplinary evaluation by a pregnancy heart team, and (3) procedural strategies to minimize fetal risk, including adherence to the "as low as reasonably achievable" (ALARA) principle. A representative clinical case illustrates application of this framework.

Antepartum transcatheter PFO closure should not be considered a routine therapeutic option during pregnancy. However, it should also not be considered an absolute contraindication when the anticipated maternal risk of recurrent embolic events clearly outweighs the fetal procedural risk under carefully controlled conditions. This SO provides a conceptual framework to guide clinical judgment in rare, highly selected cases, without advocating indications.