SCAI, in concert with the American Academy of Neurology, recommended operator and institutional volumes necessary to begin and sustain a PFO closure program. Operators should have performed >50 structural/congenital interventional procedures with either ³25 septal interventions or ³12 PFO closures. Operators should continue to perform ³30 septal interventions or ³15 PFO closures over a 2-year period. Institutions should have performed >100 structural/congenital interventional procedures in the 2 years prior to PFO program initiation. Institutions should continue to perform ³50 such procedures annually including ³25 septal interventions or ³12 PFO closures.