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

Abstract

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.

Migraine with aura: A predictor of patent foramen ovale in children and adolescents

“…Migraine with aura is an important risk factor for stroke, along with PFO. Several retrospective and prospective studies to prove the efficacy and safety of PFO closing intervention for treatment of migraine are in progress (33)(34)(35), although the migraine intervention with STARflex Õ technology I (MIST study) failed to demonstrate that any benefit from PFO closure was effective treatment (36).…”

Emergency surgical approach to device emboli due to migration of the atrial septal defect occluder

“…Other serious complications that occur in less than 1% of cases are infection, erosion into the pericardium or aorta at the rim of the device, a new ASD caused by the tearing of the thin septum primum by the lower rim, atrial fibrillation, and palpitations, which are not common and usually subside spontaneously [ 6 , 12 ]. Reporting those complicated cases should help improve the understanding of such complications, their risk factors, the delay of occurrence, the selection of patients, the implantation techniques and the design of the devices, and refine the adjuvant medical treatment [ 4 ].…”