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New Procedure Closes Holes in the Heart to Reduce Risk of Stroke

James A. Thompson, MD, is a board-certified pediatric cardiologist at the Inova Children’s Heart Program.

Every baby in the world is born with a hole in its heart. Known as the patent foramen ovale (PFO), the hole allows blood to bypass an unborn baby’s lungs. After a baby is born and starts breathing, the hole closes – most of the time.

In as many as a quarter of people, the PFO doesn’t close. Usually, it causes no problems. In a subset of people, though, the hole can raise the risk of stroke. In patients with PFO who have had a stroke, we consider closing the hole with surgery.

Now we have an exciting new way to do that. Inova is the first – and so far, only – hospital in the United States using a system called NobleStitch™ to close PFOs to prevent recurrent stroke.

a play heart with a needle and threadPFO and Stroke

Normally, the lungs filter small blood clots out of the bloodstream. In people with a PFO, clots can slip through and travel to the brain. There, they can cause a stroke.

As many as half of people who have a stroke before age 65 turn out to have a PFO. By closing the hole, we lower the risk of a second stroke 75 percent or more.

Free educational webinar: Tuesday, January 22, 2019

Join our free PFO webinar on Tues., Jan. 22 with Dr. Thompson: Click here to register online or call 1.855.My.Inova (1-855-694-6682)


To close the hole, we typically insert a device into the heart through a tiny tube, or catheter. The device is positioned on either side of the hole. Over time, heart tissue grows over it, sealing the hole. The procedure is effective and has a low risk of complications, but it isn’t perfect. For one thing, we have to leave the device behind in the heart. Sometimes, clots or infections can occur around it. The device can also cause an irregular heartbeat in some patients.

NobleStitch™ is different. This is also a minimally invasive procedure, done through a catheter. Using this technique, we stitch the hole shut with a suture, and leave nothing else behind.

Who Should Be Tested for PFO?

NobleStitch™ has been used in Europe for many years. In the U.S, it is FDA-approved for use in the heart – but it’s not specifically labeled for treating PFO. Now, Inova is leading a clinical trial of NobleStitch™ to show its effectiveness for closing these holes in people who have already had at least one stroke.

We’ve treated more than 50 patients already, from all over the country. We’ve been pleased with the results, and none of them have experienced any device-related complications.

You might be wondering if you should be tested for a PFO. Most people who have them don’t experience any problems, so we don’t recommend screening for everyone. However, if you scuba dive in deep waters, you might want to be evaluated for PFO, since it can increase the risk of decompression sickness.

There also seems to be a link between PFO and migraines, especially migraines with aura. If you have regular, debilitating migraines that haven’t responded to treatment, you might consider having a cardiac evaluation.

Most importantly, though, I urge anyone who has had an unexplained stroke to be evaluated for a PFO. Unfortunately, the holes can be hard to spot, even when you’re looking for them. It’s important to find a cardiologist who has experience in evaluating patients for PFO.

My Inova colleagues and I have treated thousands of patients with PFO, and we’re thrilled to be leading the way in this new procedure. If you are interested in NobleStitch™, contact us at 703-999-9404, or learn more about the experienced heart specialists at the Inova Heart and Vascular Institute.

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  1. […] currently being used at Inova Health System, the network of hospitals in Virginia where Thompson […]

  2. […] currently being used at Inova Health System, the network of hospitals in Virginia where Thompson […]

  3. Mary on September 25, 2018 at 2:28 pm

    Wonderful article in Post today about new technique for PFO. You performed surgery on a friend of mine and I was impressed with your demeanor and explanation of procedure.
    Friend is doing fine thanks to you.
    We also liked your socks so we called you Dr Socks.
    Keep up your important work

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