Risk and Fate of Residual Interatrial Shunting After Transcatheter Closure of Patent Foramen Ovale: a Long Term Follow Up Study

Overview

Journal Eur J Med Res

Publisher Biomed Central

Specialty General Medicine

Date 2011 Feb 25

PMID 21345765

Citations 10

Authors

Christoph Hammerstingl

B Bauriedel

C Stusser

D Momcilovic

I Tuleta

G Nickenig

D Skowasch

Affiliations

Soon will be listed here.

Abstract

Background: Percutaneous transcatheter closure of patent foramen ovale (PFO) in cryptogenic stroke is an alternative to medical therapy. There is still debate on different outcome for each currently available device. The impact of residual shunting after PFO-closure on recurrent arterial embolism is unknown. -

Aims: (i) To evaluate the prevalence of residual interatrial shunting after device- closure of PFO, (ii) to identify risk factors predicting residual interatrial shunting after device implantation, and (iii) to investigate the outcome of patients after PFO-closure during long- term follow- up (FU).

Methods And Results: Between 2000- 2005 PFO-closure was performed in 124 patients using four different devices: Amplatzer PFO-(n = 52), CardioSeal (n = 33), Helex (n = 23) and Premere (n = 16) occluder. All patients underwent serial contrast-enhanced transesophageal echocardiography (TEE) for 24 months after PFO- closure; clinical FU was at minimum 5 years up to 9.75 years (mean 6.67 ± 1.31 years). Overall-closure rate was 87% at 2 years, device-specific closure time curves differed significantly (p-logrank = 0.003). Independent risk factors for residual-shunting were implantation of a Helex occluder (hazard ratio [HR] 12.6, 95% confidence interval [CI] 2.6- 57.4, p = 0.002), PFO- canal- lengths (HR 1.2, 95%CI 1.1- 1.3, p = 0.004) and extend of atrial-septal-aneurysm (HR 1.1, 95%CI 0.9- 1.3; p = 0.05). 4 (3.2%) arterial embolic events occurred during a FU-period of 817.2 patient-years, actuarial annual thromboembolic-risk was 0.49%. All ischemic events were not related to residual PFO-shunting or device-related thrombus- formation.

Conclusion: Success rates of PFO- closure are mainly dependent on occluder-type, extend of concomitant atrial-septum-aneurysm and PFO-canal- length. Importantly, residual shunting after PFO-closure was not associated with recurrence of arterial embolism during long-term follow-up.

Citing Articles

Relation between anatomical features of patent foramen ovale and residual shunt based on transesophageal echocardiography.

Mi Z, Li C, He G, Huang D, Zhou X, Gao H Sci Rep. 2025; 15(1):1497.

PMID: 39789058 PMC: 11718188. DOI: 10.1038/s41598-024-82122-2.

Persistence of residual shunt at 6 and 12 months after transoesophageal echocardiography-guided percutaneous closure of a patent foramen ovale for cryptogenic stroke.

Witte L, El Bouziani A, Beijk M, Robbers-Visser D, Coutinho J, Tijssen J Heart. 2024; 110(19):1172-1179.

PMID: 39122559 PMC: 11883858. DOI: 10.1136/heartjnl-2024-323905.

Case Report: Persistent residual shunt after a first percutaneous PFO closure followed by minimally invasive surgical failure: third time is a charm.

Onorato E, Alamanni F, Monizzi G, Mastrangelo A, Bartorelli A Front Cardiovasc Med. 2024; 11:1367515.

PMID: 39015678 PMC: 11249728. DOI: 10.3389/fcvm.2024.1367515.

Transcatheter PFO closure for cryptogenic stroke: current approaches and future considerations.

Eltelbany M, Gattani R, Ofosu-Somuah A, Damluji A, Epps K, Batchelor W Front Cardiovasc Med. 2024; 11:1391886.

PMID: 38832314 PMC: 11144870. DOI: 10.3389/fcvm.2024.1391886.

Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges.

Devos P, Guedeney P, Montalescot G J Clin Med. 2024; 13(1).

PMID: 38202061 PMC: 10780039. DOI: 10.3390/jcm13010054.

References

Windecker S, Wahl A, Chatterjee T, Garachemani A, Eberli F, Seiler C . Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. Circulation. 2000; 101(8):893-8. DOI: 10.1161/01.cir.101.8.893. View

Droste D, Silling K, Stypmann J, Grude M, Kemeny V, Wichter T . Contrast transcranial doppler ultrasound in the detection of right-to-left shunts : time window and threshold in microbubble numbers. Stroke. 2000; 31(7):1640-5. DOI: 10.1161/01.str.31.7.1640. View

Homma S, Di Tullio M, Sacco R, Mihalatos D, Li Mandri G, Mohr J . Characteristics of patent foramen ovale associated with cryptogenic stroke. A biplane transesophageal echocardiographic study. Stroke. 1994; 25(3):582-6. DOI: 10.1161/01.str.25.3.582. View

Braun M, Gliech V, Boscheri A, Schoen S, Gahn G, Reichmann H . Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism. Periprocedural safety and mid-term follow-up results of three different device occluder systems. Eur Heart J. 2004; 25(5):424-30. DOI: 10.1016/j.ehj.2003.10.021. View

Cifarelli A, Musto C, Parma A, Pandolfi C, Pucci E, Fiorilli R . Long-term outcome of transcatheter patent foramen ovale closure in patients with paradoxical embolism. Int J Cardiol. 2009; 141(3):304-10. DOI: 10.1016/j.ijcard.2008.12.051. View

Schuchlenz H, Saurer G, Weihs W . Patent foramen ovale, atrial septal aneurysm, and recurrent stroke. N Engl J Med. 2002; 346(17):1331-2; author reply 1331-2. View

Schwerzmann M, Windecker S, Wahl A, Mehta H, Nedeltchev K, Mattle H . Percutaneous closure of patent foramen ovale: impact of device design on safety and efficacy. Heart. 2004; 90(2):186-90. PMC: 1768045. DOI: 10.1136/hrt.2002.003111. View

OGara P, Messe S, Tuzcu E, Catha G, Ring J . Percutaneous device closure of patent foramen ovale for secondary stroke prevention: a call for completion of randomized clinical trials: a science advisory from the American Heart Association/American Stroke Association and the American College of.... Circulation. 2009; 119(20):2743-7. DOI: 10.1161/CIRCULATIONAHA.109.192272. View

Homma S, Sacco R, Di Tullio M, Sciacca R, Mohr J . Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation. 2002; 105(22):2625-31. DOI: 10.1161/01.cir.0000017498.88393.44. View

10.

Messe S, Silverman I, Kizer J, Homma S, Zahn C, Gronseth G . Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004; 62(7):1042-50. DOI: 10.1212/01.wnl.0000119173.15878.f3. View

11.

Meier B, Lock J . Contemporary management of patent foramen ovale. Circulation. 2003; 107(1):5-9. DOI: 10.1161/01.cir.0000046073.34261.c1. View

12.

von Bardeleben R, Richter C, Otto J, Himmrich L, Schnabel R, Kampmann C . Long term follow up after percutaneous closure of PFO in 357 patients with paradoxical embolism: Difference in occlusion systems and influence of atrial septum aneurysm. Int J Cardiol. 2008; 134(1):33-41. DOI: 10.1016/j.ijcard.2008.02.031. View

13.

Windecker S, Meier B . Is closure recommended for patent foramen ovale and cryptogenic stroke? Patent foramen ovale and cryptogenic stroke: to close or not to close? Closure: what else!. Circulation. 2008; 118(19):1989-98. DOI: 10.1161/CIRCULATIONAHA.107.757013. View

14.

Anzola G, Morandi E, Casilli F, Onorato E . Does transcatheter closure of patent foramen ovale really "shut the door?" A prospective study with transcranial Doppler. Stroke. 2004; 35(9):2140-4. DOI: 10.1161/01.STR.0000137764.07815.de. View

15.

Mohr J, Homma S . Patent cardiac foramen ovale: stroke risk and closure. Ann Intern Med. 2003; 139(9):787-8. DOI: 10.7326/0003-4819-139-9-200311040-00015. View

16.

Lechat P, Mas J, Lascault G, Loron P, Theard M, Klimczac M . Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988; 318(18):1148-52. DOI: 10.1056/NEJM198805053181802. View

17.

Coats A . Ethical authorship and publishing. Int J Cardiol. 2008; 131(2):149-50. DOI: 10.1016/j.ijcard.2008.11.048. View

18.

Messe S, Kasner S . Is closure recommended for patent foramen ovale and cryptogenic stroke? Patent foramen ovale in cryptogenic stroke: not to close. Circulation. 2008; 118(19):1999-2004. DOI: 10.1161/CIRCULATIONAHA.107.757021. View

19.

Homma S, Sacco R . Patent foramen ovale and stroke. Circulation. 2005; 112(7):1063-72. DOI: 10.1161/CIRCULATIONAHA.104.524371. View

20.

Webster M, Chancellor A, Smith H, Swift D, Sharpe D, Bass N . Patent foramen ovale in young stroke patients. Lancet. 1988; 2(8601):11-2. DOI: 10.1016/s0140-6736(88)92944-3. View