Percutaneous Closure of Patent Foramen Ovale: A Case Series and Literature Review

Abstract

Patent foramen ovale (PFO) is an anatomical variant of the interatrial septum with an overall prevalence of 27% in autopsy studies. PFOs have a potential role in causation of stroke, platypneaorthodeoxia, decompression sickness, right to left shunt and migraine headaches. Data regarding percutaneous closure of PFO in low volume tertiary care centers is lacking. Retrospective review of 14 percutaneous PFO closures done in our facility from March 2005 to August 2006 was performed for efficacy of procedure and safety.All patients received clopidogrel for a period of 3 months, and aspirin and subacute bacterial endocarditis prophylaxis for 6 months. Mean age of the study population was 54 years. Fifty percent (7 of 14) of patients experienced an atrial septal aneurysm and 14% (2 patients) exhibited a hypercoagulable state.The indication for closure in 13 patients was transient ischemic attacks or strokes, while one patient had persistent hypoxia due to a severe right to left shunt at PFO. Patients received either a CardioSEAL or Amplatzer device. Deployment rate was 100%. All patients completed a minimum of 6 months of follow-up, with a mean follow-up time of 14.9 ± 7.6 months. No immediate or late bleeding complication occurred in any patient. One patient developed paroxysmal atrial fibrillation and one patient developed thrombotic complications at 7 months post-procedure secondary to the progression of her anal carcinoma and subsequently died. Pending the results of the four large randomized trials that are enrolling patients, percutaneous closure of PFO for cryptogenic strokes is an attractive alternative to lifelong anticoagulation with relatively few complications, even in low volume centers.There are many challenges in the management of this subset of patients, the foremost being the selection of a target patient population. Role of PFO in migraines is less clear. Pat ent foramen ovale (PFO) is an anatomical variant of the interatrial septum, which until recently was believed to be of no clinical importance. Evidence emerging over the past 15 years suggests a role for PFO in cryptogenic stroke, platypnea-orthodeoxia, decompression sickness, right to left shunt and migraine headaches. Better diagnostic modalities for its detection and improved methods of closure, including percutaneous approach have become available for clinical practice.PFO is a congenital defect occurring in the septum separating the two atrial chambers. PFO provides communication between the atrial chambers of the heart through fossa ovalis on the right side and the ostium secundum on the left side. Septum primum acts as a one-way valve allowing blood flow from the right to left atria, bypassing the lungs. 1 This septum normally remains patent before birth and closes with the first breath of air that a baby takes because of increased left sided pressures. Anatomical closure usually occurs by 2 years of age. However, it remains patent in a subset of the population. Autopsy studies have shown an overall prevalence of 27% in the general populat...

Oclusão percutânea do forame oval patente com prótese PREMERE TM: resultados preliminares da primeira experiência no Brasil

“…[7][8][9][10][11][12][13][14][15] Como desvantagens do dispositivo na oclusão do forame oval patente poderíamos citar o elevado perfil do sistema liberador da prótese (13 F) e a relativa contraindicação de implante em pacientes portadores de forame oval patente associado a grandes aneurismas do septo interatrial. Consideramos esta última uma contraindicação relativa ao uso da PREMERE TM , porque, nesses casos, a análise da "boca" do forame oval patente é muito importante.…”

Delayed reopening of a hemodynamically significant patent foramen ovale after left lung transplantation: Emergency management

“…Percutaneous closure of the PFO has been shown to be effective in the case of right-to-left shunting with normal pulmonary arterial pressure, but its indication remains controversial in other situations. 1,[3][4][5] Here, we report the case of a delayed reopening of a PFO after single lung transplantation.…”

Percutaneous closure of the patent foramen ovale: A cardiological perspective

“…(29,35,(48)(49)(50) and major complications (tamponade, infection, thrombus formation) in less than 1.5% of cases respectively. (10,41,42,53,54) Late erosions into surrounding tissues have been described with all intracardiac devices, but are rare after PFO closure. Residual shunts are common immediately following implantation, but infrequent (5-10%) after 12 months.…”

“…(10,(34)(35)(36) Interestingly, some of the recurrent ischaemic episodes occurred in patients where no residual shunts could be detected, probably indicating that other underlying mechanisms are involved in the pathogenesis of stroke.…”

“…(7)(8)(9)(10) transcranial Doppler (tCD) TCD is highly sensitive and specific for the diagnosis of right to left shunts and is the preferred screening tool. (11) TCD does not cause any discomfort to patients and requires no sedation.…”