Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent paradoxical embolism

Summary

The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on patent foramen ovale for the prevention of cerebral embolic stroke in January 2005.

The Interventional Procedures Advisory Committee (IPAC) reviewed this guidance in June 2010 and draft guidance was issued for a four week public consultation, which closed on 24 August 2010.

During this process the IP Programme became aware of a number of relevant trials, the results of which may substantially change the evidence base. As a result, NICE has delayed publication of the new guidance.

Until the new guidance is published the NHS should continue to follow the recommendations in the January 2005 guidance below.

If you wish to be updated to any developments with this procedure, please express an interest here.

Description

The foramen ovale is a hole in the wall that divides the two upper chambers of the heart at the level of the atria. The hole is present in the heart of a developing fetus, but normally closes up soon after the baby is born. If it fails to close it is known as a patent foramen ovale (PFO) and in most people causes no problems. However, some studies have shown that having a PFO can increase the chance of substances (e.g. gas bubbles or blood clots) crossing from the right side into the left side of the heart, and from there into the arterial circulation system where they may block blood vessels and cause serious problems such as a stroke.

This procedure involves passing a device through a large vessel in the groin up into the heart and closing/blocking the hole in the wall. The aim is to lower the chances of substances crossing the heart and causing serious problems.

NICE Pathways

This guidance has been incorporated into the following NICE Pathways, along with other related guidance and products.

Visit the NICE Pathway: stroke

OPCS4.6 Code(s):

K16.5 Percutaneous transluminal closure of patent oval foramen with prosthesis

Y53.- Approach to organ under image control

Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

Details

Contact details:

Links:

	Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent paradoxical embolism - Consultation Document	26 July 2010
	Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent paradoxical embolism - Overview	26 July 2010
	IPG109 Percutaneous closure of patent foramen ovale for the prevention of cerebral embolic stroke: guidance	26 January 2005
	IPG109 Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent paradoxical embolism: guidance (Web format)	14 February 2011
	IPG109 Percutaneous closure of patent foramen ovale for the prevention of cerebral embolic stroke: understanding NICE guidance	26 January 2005
	IPG109 Cau fforamen hirgrwn agored trwy'r croen er mwyn atal strôc embolig ymenyddol: deall canllawiau NICE	29 May 2009
	Interventional procedure consultation document - percutaneous closure of patent foramen ovale for the prevention of cerebral embolic stroke	31 August 2004
	Overview of percutaneous closure of patent foramen ovale for the prevention of cerebral embolic stroke	31 August 2004