carl
It is not often that three interventional cardiac procedures are completed before the morning coffee break. But at One Welbeck Heart Health, Dr Iqbal Malik, a Consultant Cardiologist at the London Cardiovascular Clinic, recently performed three PFO (Patent Foramen Ovale) closures in a single morning, all completed before 10 a.m.
This is not about speed. It is about experience, efficiency, and a well-coordinated team delivering complex care to the highest standards.
What is a PFO?
A patent foramen ovale (PFO) is a flap-like hole between the atria of the heart. It should close shortly after birth, but around one in four adults does not. In most people, this remains harmless and undiagnosed. However, for patients who have experienced unexplained strokes or transient ischaemic attacks, a PFO can allow a blood clot to bypass the lungs and enter the arterial system, potentially reaching the brain.
PFO closure is a simple and effective day-case procedure that reduces the risk of recurrent stroke in carefully selected patients. It involves guiding a closure device through the femoral vein to the heart, sealing the opening, and reducing the chance of paradoxical embolism.
To learn more about the procedure, visit the London Cardiovascular Clinic’s PFO Closure page.
A Closer Look at the Morning’s Procedures
The morning included three different patients, each presenting a different anatomical challenge.
- The first patient had a very tight PFO tunnel that was difficult to cross with the catheter. This added time and required a more deliberate approach.
- The second case was straightforward. Standard anatomy and a routine deployment made this one of the smoother procedures of the day.
- The third patient had a large PFO, which initially required a large closure device. Once deployed, it appeared slightly oversized. Dr Malik quickly adjusted the approach and replaced it with a smaller device. This decision, made in real time, reflects the importance of experience and good judgement in interventional cardiology.
Dr Malik noted, “You could say I did four procedures, as I used four devices.” It was a small moment of humour in an otherwise carefully planned and executed clinical session.
Why Experience Matters
This kind of procedural volume and variability highlights why experience is so important. While “minimally invasive” suggests simplicity, every heart is different. No PFO closure is entirely routine.
Adjusting to complex anatomy, deciding when to push through or step back, and choosing the right size and type of device require both skill and judgement. Following protocol is not enough. You need clinical experience and a team you trust.
Dr Malik has performed hundreds of these procedures over two decades. His clinic, the London Cardiovascular Clinic, sees a large number of patients referred for PFO closure evaluation each year, often following cryptogenic stroke or migraine-related symptoms.
Teamwork at One Welbeck
Dr. Malik was clear that the morning’s success depended on more than just the person performing the procedure. It was a team effort. Completing three interventional cases before 10 a.m. required careful planning, clear protocols, and strong communication.
Each case followed a six-step process:
- Pre-operative patient assessment
- Patient preparation on the day
- Theatre transfer and setup
- Interventional procedure
- Recovery and observation
- Same-day discharge with follow-up planning
The One Welbeck team was 15 minutes behind schedule at the start, but all three patients were treated and safely moved to recovery by 10 am. This level of coordination is only possible with a team trained to work at this level of precision.
What This Means for Patients
For patients with a history of unexplained stroke or those diagnosed with PFO following neurological investigation, closure offers a safe and effective treatment. The procedure is completed under local anaesthesia and sedation. Most patients go home on the same day.
The risks are low, and the benefits are well-established in selected cases. Studies such as the RESPECT and CLOSE trials have shown that PFO closure significantly reduces the risk of recurrent stroke in appropriately chosen patients.
Patients at the London Cardiovascular Clinic receive a full workup before any intervention. This includes imaging, neurology review where appropriate, and a discussion about the risks and benefits of closure. No two patients are alike, and the decision to close is always individual.
A Model of High-Performance Medicine
This morning at One Welbeck, it was not just about volume. It demonstrated how high-quality private medicine can work when clinical expertise meets operational efficiency.
With direct referrals, same-week appointments, and day case procedures, patients at the London Cardiovascular Clinic receive fast, focused care aligned with the latest clinical evidence.
It also shows how those with experience best deliver specialist services like PFO closure. When complications arise, or anatomy is complex, you want a clinician who has seen it all before.
Dr Malik and his team deliver that level of care — not occasionally, but routinely.
To refer a patient or learn more about PFO closure, visit the London Cardiovascular Clinic’s PFO Closure treatment.
