Inclusion Criteria:  PFO ASD (less than 1 cm with redundant septal tissue) Trans Septal Puncture Sites ASA (when an appropriate PFO or small ASD defect is present) Stroke Trans Ischemic Attack (TIA) Platypnea Orthodeoxia Syndrome Decompression Illness  Exclusion Criteria:  Patients under 18 years and over 65 years of age Patients who are not fluent in English