Background-The

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Zoghbi et al 437 † More specific in peri-procedural or early post-procedural assessment. Holodiastolic flow reversal may not be seen in severe bradycardia. ‡ Dependent on aortic compliance; limits its utility in the elderly population; influenced by heart rate. §The vena contracta area is measured by planimetry of the vena contracta of the jet(s) on 2D or 3D color Doppler images in the short-axis view.k Measured as the sum of the circumferential lengths of each regurgitant jet vena contracta (not including the non-regurgitant space between the separate jets) divided by the circumference of the outer edge of the valve.

Background-Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with paradoxical embolism and PFO. Methods and Results-We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47Ϯ14 years) who underwent transcatheter closure of PFO because of paradoxical embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experienced recurrent neurological events (1 fatal stroke and 1 transient ischemic attack), representing an annual risk of recurrence of 0.9%. In addition, 4 (3.6%) of the patients required reintervention for device malalignment or significant shunt. Kaplan-Meier analysis showed a freedom from recurrent embolic events and reintervention of 96% and 90% at 1 and 5 years, respectively. Conclusions-Transcatheter closure of PFO is a safe and effective therapy for patients with paradoxical embolism and PFO. It is associated with a high success rate, low incidence of hospital complications, and low frequency of recurrent systemic embolic events.

Urgent/emergent TAVR is feasible with acceptable outcomes and may be a reasonable option in a selected group of patients with severe AS.

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