Five-Year Experience With Percutaneous Closure of Patent Foramen Ovale

Abstract

Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke, arterial desaturation, decompression illness, and migraine headache (MH). This study evaluated the safety of percutaneous transcatheter PFO closure in patients with cryptogenic stroke, transient ischemic attack, or arterial desaturation. Additionally, symptomatic reduction in MH was determined after interatrial shunt closure. Of the 252 patients referred to the University of California, Los Angeles, with PFO, 131 underwent closure of the interatrial communication with a CardioSEAL (n ‫؍‬ 30) or Amplatzer (n ‫؍‬ 101) device. PFO morphology was evaluated with transesophageal echocardiography. Follow-up was conducted at 1 to 2 months with echocardiography, with clinical assessment annually thereafter. At an average follow-up of 30 months, there was no recurrence of any thromboembolic event (transient ischemic attack, stroke, or peripheral). There was a reduction in MH, defined as the complete resolution of headache or a >50% reduction in the number of headache days, in 85% of patients after PFO closure. Temporary problems after device implantation, including chest discomfort and palpitations, were reported in 23% of patients and occurred more frequently in patients with nickel hypersensitivity (p <0.05). In conclusion, transcatheter PFO closure is an effective and safe therapeutic modality in the prevention of thromboembolic events and MH associated with interatrial shunting in patients who present with cryptogenic stroke. Pending randomized, controlled trials are necessary to determine if this invasive approach is preferable to medical therapy for the prevention of recurrent stroke or as primary treatment for patients with MH.

Unusual Presentation of Nickel Allergy Requiring Explantation of an Amplatzer Atrial Septal Occluder Device

“…To our knowledge this is only the third reference in the literature to a likely nickel allergy to an implanted transcutaneous PFO occlusion device requiring explantation. 1,2 Slavin and colleagues reported a significant increase in the incidence of migraine headaches and palpitations in patients undergoing Amplatzer device deployment and who were later found to have nickel allergies, 8 emphasizing the potential relevance even if the devices were not explanted. Lai and colleagues reported a case of likely nickel allergy to an Amplatzer device in which the patient complained of intermittent episodes of substernal chest pressure progressing to severe left scapular discomfort, which was successfully treated with steroids.…”

Is cryptogenic stroke a tenable diagnosis? The Milpark Hospital patent foramen ovale closure experience

“…This has been confi rmed in several observational studies and meta-analyses. (17,18,19,20,21) Our reported series demonstrates the importance of taking an adequate history, and not always accepting an "obvious" pathology as the cause of the neurological defi cit or vascular event. These cases emphasise the need to reassess patients, particularly when symptoms…”

Evolução clínica da enxaqueca após oclusão percutânea de forame oval patente

“…Esses pacientes foram, então, encaminhados pelas equipes clínicas de Neurologia e Cardiologia para o Laboratório de Hemodinâmica, a fim de se proceder à oclusão percutânea do FOP com prótese 11 . Após a realização dos procedimentos, os pacientes retornaram ao acompanhamento ambulatorial, com reavaliação dos critérios pré-operatórios.…”