Effect of Percutaneous Closure of Patent Foramen Ovale on Post-Procedural Arrhythmias

Gaspardone, Achille; Giardina, Andrea; Iamele, Maria; Gioffrè, Gaetano; Polzoni, Mauro; Lamberti, Filippo; Remoli, Romolo; Sgueglia, Gregory A.; Papa, Marco; Iani, Cesare

doi:10.1016/j.jacc.2013.07.084

Cited by 18 publications

(14 citation statements)

References 4 publications

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“…Meta-analyses of observational studies have indicated that the prevalence of PFO is approximately three times higher in patients with cryptogenic stroke and migraine than in the controls. Conversely, the observational evidence indicates a two to three fold increased prevalence of migraine and cerebrovascular events in PFO carriers 12). The analysis of the 16 patients who underwent percutaneous closure of PFO with Amplatzer devices demonstrated the relative safety of percutaneous transcatheter PFO closure in patients with cryptogenic stroke or TIA.…”

Section: Discussionmentioning

confidence: 99%

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Intermediate and Long-Term Results of Transcatheter Closure of Patent Foramen Ovale Using the Amplatzer Patent Foramen Ovale Occluder: One Case of Pulmonary Embolism Irrespective of Patent Foramen Ovale Closure

et al. 2011

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Background and ObjectivesPatent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke or transient ischemic attack (TIA) due to paradoxical embolism, and in the pathogenesis of migraine. This paper reports the intermediate and long-term results of transcatheter closure of PFO associated with cerebrovascular accidents (CVAs), TIAs and migraine, using the Amplatzer PFO occluder. This paper also reports a case of pulmonary embolism which developed in one patient after PFO closure.Subjects and MethodsFrom January 2003 to May 2010, 16 patients with PFO (seven males and nine females) with a history of at least one episode of cryptogenic stroke/TIA, CVA, or migraine and who underwent percutaneous transcatheter closure of PFO using the Amplatzer occluder. All the procedures were performed under general anesthesia and were assisted by transesophageal echocardiography.ResultsThe device was implanted without any significant complications in all the patients, and the PFOs were effectively closed. At an average follow-up period of 54 months, the 15 patients with TIA/CVA had no recurrence of any thromboembolic event. The symptoms in one patient with migraine subsided after occlusion of the PFO. In this study, pulmonary embolism occurred five months after PFO closure in one patient, but the cause of pulmonary embolism was not identified. However, it is believed that the pulmonary embolism occurred without stroke recurrence because occlusion of the PFO was performed when the patient had a stroke event.ConclusionIt can be concluded that according to the intermediate and long-term follow-up results, transcatheter PFO closure is an effective and safe therapeutic modality in the prevention of thromboembolic events, especially in the patients with cryptogenic stroke/TIA, and PFO closure is helpful in the treatment of migraine. However, this study involved a small number of patients and also the follow-up period was not long enough. Hence, randomized, controlled trials are necessary to determine if this approach is preferable to medical therapy for the prevention of recurrent stroke or as primary treatment for patients with migraine headache.

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Section: Discussionmentioning

confidence: 99%

“…PFO has been implicated in the pathogenesis of cryptogenic stroke and TIA due to paradoxical embolism, and in the pathogenesis of migraine 12). The increased risk of stroke in patients with migraine could be explained by the patients' increased propensity to paradoxical embolism 2).…”

Section: Discussionmentioning

confidence: 99%

Intermediate and Long-Term Results of Transcatheter Closure of Patent Foramen Ovale Using the Amplatzer Patent Foramen Ovale Occluder: One Case of Pulmonary Embolism Irrespective of Patent Foramen Ovale Closure

et al. 2011

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“…These reports revealed the hazard of AF among patients receiving PFO closure to be at least 3 times as high as that among patients receiving medical therapy (OR= 3.72; and HR= 3.22 in the 2 studies respectively). Multiple plausible explanations include the presence of a residual shunt after device closure , device‐related atrial mechanical stretch , enhancement of atrial automaticity and promoting re‐entry mechanism , and the presence of preclosure silent atrial arrhythmias by Holter monitoring or external loop recorder .…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of patent foramen ovale closure or medical therapy after cryptogenic stroke: A meta‐analysis of randomized trials

Abdelaziz

Saad

Abuomara

et al. 2018

Cathet Cardio Intervent

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“…In most cases, the embolic source remains undetermined; in fact, deep venous thrombosis is found only in 5%–10% of cases. 31 Only in a few cases is it possible to identify overt risk factors for thromboembolism such as trauma, oral contraceptives, or hypercoagulable states. 32 Therefore, it was hypothesized that the thrombus formation can take place in situ, just in the PFO (it is morphologically similar to a tunnel), or on the surface of the aneurysm, especially if fixed, given the occurrence of the phenomena of blood stasis inside it.…”

Section: Discussionmentioning

confidence: 99%

Transient cerebral ischemia in an elderly patient with patent foramen ovale and atrial septal aneurysm

Merante

Gareri²,

Castagna³

et al. 2015

CIA

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Cerebrovascular disease is one of the most common causes of cerebrovascular morbidity and mortality in developed countries; up to 40% of acute ischemic strokes in young adults are cryptogenic in nature – that is, no cause is determined. However, in more than half of these patients, patent foramen ovale (PFO) is seen along with an increased incidence of atrial septal aneurysm (ASA). The following is a report of an interesting case: a 68-year-old man with ASA and transient cerebral ischemia. Transesophageal echocardiography (TEE) showed the presence of ASA; a test with microbubbles derived from a mixture of air and saline or colloids pointed out a shunt on the foramen ovale following Valsalva’s maneuver. The patient underwent percutaneous transcatheter closure of the interatrial communication by an interventional cardiologist. TEE and transcranial Doppler or TEE with the microbubbles test are the recommended methods for detecting and quantifying intracardiac shunts, both at rest and following Valsalva’s maneuver. In patients following the first event of transient ischemic attack, and without clinical and anatomical risk factors (such as the presence of ASA, PFO, and basal shunt), pharmacological treatment with antiplatelets or anticoagulants is closely recommended. On the contrary, in patients following the first event of transient ischemic attack, or a recurrent event during antiplatelet treatment, the percutaneous closure of PFO is recommended.

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Effect of Percutaneous Closure of Patent Foramen Ovale on Post-Procedural Arrhythmias

Cited by 18 publications

References 4 publications

Intermediate and Long-Term Results of Transcatheter Closure of Patent Foramen Ovale Using the Amplatzer Patent Foramen Ovale Occluder: One Case of Pulmonary Embolism Irrespective of Patent Foramen Ovale Closure

Intermediate and Long-Term Results of Transcatheter Closure of Patent Foramen Ovale Using the Amplatzer Patent Foramen Ovale Occluder: One Case of Pulmonary Embolism Irrespective of Patent Foramen Ovale Closure

Long‐term outcomes of patent foramen ovale closure or medical therapy after cryptogenic stroke: A meta‐analysis of randomized trials

Transient cerebral ischemia in an elderly patient with patent foramen ovale and atrial septal aneurysm

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