Transcatheter treatment of atrial septal aneurysm associated with patent foramen ovale for prevention of recurrent paradoxical embolism in high-risk patients

Wahl, Andreas; Meier, Bernhard; Schwerzmann, Markus; Becker, U.; Seiler, Christian; Arnold, Marcel; Mattle, Heinrich; Krumsdorf, Ulrike; Sievert, Horst; Ostermayer, Stefan; Billinger, Kai; Windecker, Stephan

doi:10.1016/j.jacc.2004.10.043

Cited by 126 publications

(101 citation statements)

References 11 publications

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“…One study compared clinical outcome after device closure between patients with both PFO and atrial septal aneurysm (nϭ141) and those with PFO alone (nϭ220). 71 Device implantation success and the rate of residual shunt as assessed by transesophageal echocardiography 6 months after the procedure were similar for both groups. At 4 years of follow-up, the rate of recurrent stroke, TIA, or peripheral embolism amounted to 5.1% and 6.0% in patients with and without associated PFO (hazard ratioϭ0.8; 95% CI, 0.3 to 2.3; Pϭ0.70).…”

Section: Comparison Of Medical Treatment Withmentioning

confidence: 74%

Patent Foramen Ovale and Cryptogenic Stroke: To Close or Not to Close? Closure: What Else!

Windecker

Meier

2008

Circulation

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A 39-year-old mother of 2 teenage boys complained of severe migraine with aura for Ͼ10 years. Otherwise healthy, she suffered an ischemic stroke that rendered her permanently aphasic. Diagnostic evaluation revealed no evidence of atherosclerosis of the carotid arteries or plaques of the ascending aorta and the aortic arch. The ECG showed normal sinus rhythm, and the patient denied any history of palpitations or arrhythmias. Echocardiography documented normal ventricular function without wall motion abnormalities or evidence of thrombus and normal-appearing valves but a large patent foramen ovale (PFO). The most likely clinical diagnosis is stroke due to paradoxical embolism. The patient's neurologist recommended PFO closure. However, guidelines regarding PFO closure from professional societies remain ambiguous because of insufficient evidence regarding therapeutic measures (Table 1). 1,2 Response by Messé and Kasner p 1998Stroke is the third leading cause of mortality and the most important cause of serious, long-term disability in developed countries. 3 The presented case is testimony to the sad sequelae of stroke that may deprive someone permanently of speech, an emotional and mental tragedy. A classic etiology is not found in up to 40% of ischemic strokes despite an extensive diagnostic evaluation. This is referred to as cryptogenic stroke, a term that strangely ignores the role of the PFO. 4 The foramen ovale is an opening in the atrial septum secundum, with the septum primum functioning as a 1-way valve allowing right-to-left shunt during in utero development. The postnatal decrease in right atrial pressure results first in functional followed by anatomic closure in the ensuing months. Autopsy studies show that fusion of the 2 septae fails to occur in Ϸ1 of 4 people. 5 This is referred to as PFO and represents the most common congenital abnormality. 6 Paradoxical embolism via a PFO has been documented as a stroke mechanism, 7-10 and therapeutic measures aimed at secondary prevention intend to eliminate thrombus formation or its embolization. [11][12][13][14] In the United States, nearly 800 000 strokes occur yearly, of which 10% to 40% are presumed to be cryptogenic (according to the old definition that does not take into account the PFO). Of these, 50% of patients have a PFO. 3 Accordingly, 40 000 to 160 000 of strokes may be attributable to PFO per annum. Association by Chance or Cause-and-Effect RelationshipPart of the controversy surrounding percutaneous PFO closure relates to the fact that paradoxical embolism is rarely a

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Section: Comparison Of Medical Treatment Withmentioning

confidence: 74%

Patent Foramen Ovale and Cryptogenic Stroke: To Close or Not to Close? Closure: What Else!

Windecker

Meier

2008

Circulation

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“…5,6 During long-term follow-up, recurrence of ischemic events such as stroke, transient ischemic event, or peripheral emboli has been analyzed. 2,3,7 With respect to safety complications during device implantation, 2 atrial erosion 8 and thrombus formation on the device 4 were the focus. Very recently with sequential echocardiographic studies, a new long-term safety aspect has been addressed.…”

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confidence: 99%

Impact of Percutaneous Device Implantation for Closure of Patent Foramen Ovale on Valve Insufficiencies

et al. 2009

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Background-In patients with percutaneous device implantation for closure of patent foramen ovale (PFO), a 10% incidence of new or worsened aortic regurgitation within 12 months has been reported with echocardiography. Cardiac magnetic resonance imaging is a powerful noninvasive tool to quantify volume and fraction of valve insufficiencies. We studied the acute and long-term impact of percutaneous device implantation for PFO closure on valve insufficiencies in cardiac magnetic resonance imaging. Methods and Results-Sequential cardiac magnetic resonance imaging studies were performed in 102 patients with cryptogenic ischemic events. Cardiac magnetic resonance imaging was performed before PFO closure, the day after device implantation, and at 12 months of follow-up. There was no difference in volumetric and hemodynamic parameters before PFO closure compared with 12 months of follow-up. With a cutoff for relevant regurgitation fraction of 5%, there were no statistically significant differences in regurgitation fraction of the semilunar and atrioventricular valves. The median fraction of aortic valve insufficiency was 3.9% (interquartile range [IQR] 2.0% to 5.1%) before PFO closure, 5.4% (IQR 4.1% to 5.9%) after device implantation, and 4.3% (IQR 3.3% to 6.0%) at 12 months of follow-up. The size and type of the occluder had no impact on aortic valve insufficiency. Median regurgitation fraction for the pulmonary valve was 3.6% (IQR 2.4% to 6.7%) before intervention, 7.3% (IQR 5.1% to 8.2%) after occluder implantation and 5.8% (IQR 4.8% to 7.4%) at 12 months of follow-up. Values for the mitral valve were 3.1% (IQR 1.4% to 6.0%), 5.5% (IQR 3.5% to 7.3%), and 3.8% (IQR 1.5% to 7.9%) and for the tricuspid valve were 5.4% (IQR 0.1% to 8.8%), 5.8% (IQR 1.4% to 9.2%), and 6.0% (IQR 1.1% to 8.4%), respectively. Conclusions-Percutaneous

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“…(48,51,54) The same holds true for residual shunts and thrombus formation. (55) Erosions of the free atrial wall, more a threat with the larger devices used but rather optically facilitated (56) (Figure 5).…”

Section: Percutaneous Pfo Closurementioning

confidence: 80%

Closure of patent foramen ovale for secondary prevention of cerebrovascular events

Wahl

Meier

2017

SAHJ

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Transcatheter treatment of atrial septal aneurysm associated with patent foramen ovale for prevention of recurrent paradoxical embolism in high-risk patients

Cited by 126 publications

References 11 publications

Patent Foramen Ovale and Cryptogenic Stroke: To Close or Not to Close? Closure: What Else!

Patent Foramen Ovale and Cryptogenic Stroke: To Close or Not to Close? Closure: What Else!

Impact of Percutaneous Device Implantation for Closure of Patent Foramen Ovale on Valve Insufficiencies

Closure of patent foramen ovale for secondary prevention of cerebrovascular events

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