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

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Interventional Cardiology

Background:

• Transcatheter closure of a patent foramen ovale (PFO) during pregnancy is typically avoided due to fetal safety and radiation concerns.
• Pregnancy is a hypercoagulable state, increasing the risk of embolic events in some PFO patients postpartum.
• Current guidelines lack clear definitions for evaluating exceptional antepartum PFO closure cases.

Purpose of the Study:

• To synthesize current recommendations and literature regarding antepartum PFO closure.
• To propose a structured framework for decision-making in select pregnant patients with PFO.
• To guide clinical judgment in rare, highly selected cases of PFO during pregnancy.

Main Methods:

• Synthesis of European Society of Cardiology guidelines (2025) on cardiovascular disease in pregnancy.
• Review of relevant scientific literature on PFO closure during pregnancy.
• Development of a framework focusing on maternal risk stratification, multidisciplinary evaluation, and fetal risk minimization.

Main Results:

• Antepartum transcatheter PFO closure is not a routine option during pregnancy.
• Closure may be considered if maternal embolic risk significantly exceeds fetal procedural risk.
• A framework is proposed for evaluating high-risk, selected cases.

Conclusions:

• Antepartum PFO closure is not routinely indicated but not absolutely contraindicated.
• A multidisciplinary approach and rigorous risk assessment are crucial.
• Careful consideration of maternal versus fetal risk is essential for decision-making in exceptional circumstances.