Comparison of Outcomes after Device Closure with Transseptal Puncture and Standard Technique in Patients with Patent Foramen Ovale and Ischemic Events

Moon, Jeonggeun; Kang, Woong Chol; Kim, Sihoon; Kim, Myeong Gun; Oh, Pyung Chun; Park, Yae Min; Chung, Wook‐Jin; Choi, Do Il; Lee, Ji Yeon; Lee, Yeong-Bae; Ahn, Taehoon

doi:10.1111/joic.12296

Cited by 7 publications

(7 citation statements)

References 17 publications

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“…We assumed that the application of transseptal puncture may have contributed to the large residual shunt. Transseptal puncture technique may be an effective option for facilitating device closure after the failure of conventional approach, but an increased incidence of residual shunt was observed with this technique [23]. Comparative studies between Cardi-O-fix PFO occluder and other type of occluders have been rarely conducted.…”

Section: Discussionmentioning

confidence: 99%

Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Han

Zhang

2020

J Cardiothorac Surg

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Background: Percutaneous closure of patent foramen ovale (PFO) is routinely performed using plain fluoroscopy in the catheter room. This method results in inevitable radiation damage, adverse effects of contrast agents on kidneys, and high cost. We performed PFO closure with a simplified and economical transesophageal echocardiography (TEE)-only guided approach in the operating room. This study aimed to investigate the feasibility, safety, and effectiveness of the percutaneous closure of PFO by only using TEE. Methods: We reviewed the medical records of patients who underwent percutaneous PFO closure at our center from December 2013 to December 2017. A total of 132 patients with PFO and cryptogenic strokes underwent PFO closure by using cardi-O-fix PFO device under TEE guidance. The participants comprised 64 and 68 male and female patients, respectively. The mean age and body weight of the patients were 39.40 ± 13.22 years old (12-68 years old) and 65.42 ± 9.70 kg (40-95 kg), respectively. All patients only received aspirin (3-5 mg/kg body weight, oral administration) for 6 months. Contrast-enhanced transthoracic echocardiography (c-TTE) with Valsalva maneuver was performed during follow-up, and questionnaire surveys were obtained at 3, 6, and 12 months after the procedure. Results: All (100%) patients were successfully closed. Follow-ups were conducted for 13 months to 48 months, with an average of 27 months. No severe complications were found during the follow-up period. Paroxysmal atrial fibrillation occurred in 4 patients within 3 months after the procedure. No recurrent stroke or death occurred in all patients during the follow-up period. Transient ischemic attack occurred in one patient 6 months after the procedure. Ten (7.6%) patients had a right-to-left shunt, as demonstrated by c-TTE at 12 months of follow-up. Among the 57 patients suffering from migraine, significant relief or resolution was reported by 42 (73.7%) patients. Conclusion: TEE-only guided PFO closure was a safe, feasible, and effective method that did not require the use of X-rays and contrast agents.

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Section: Discussionmentioning

confidence: 99%

Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Han

Zhang

2020

J Cardiothorac Surg

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“…PFO closure was determined according to the heart team's discretion (the team consisted of a cardiologist, a neurologist, and a radiologist) based on clinical data, echocardiographic findings, and patients’ preference. Seventy patients (27%) with a mild grade PFO shunt and 27 patients (11%) that had previously undergone PFO closure using the transseptal puncture technique were excluded . Finally, 158 patients (men 120, overall mean age 49.9 years) were included in the study.…”

Section: Methodsmentioning

confidence: 99%

Effect of patent foramen ovale closure for prevention on recurrent stroke or transient ischemic attack in selected patients with cryptogenic stroke

Kim

Kim²,

Moon

et al. 2017

J Interven Cardiology

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Baseline characteristics were similar between the two groups, except age which was younger in the closure group (47.7 ± 10.8 vs 51.9 ± 9.9, P = 0.013), and the presence of shunt at rest was more common in the closure group (35.8% vs 10.4%, P = 0.000). Procedural success was 94.0%. Over a mean follow-up of 27.8 months, a total of six primary end point, all of which were strokes, occurred only in the medication group (6.6% vs 0%, P = 0.039). Stroke-free survival rate was significantly higher in the closure group (P = 0.026) CONCLUSIONS: Our study showed that PFO closure may be an effective treatment strategy to prevent recurrent stroke or TIA for patients with CS if it is conducted in selective patients who have PFO shunt more than moderate grade.

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“…PFO closure was determined according to the discretion of the heart team (consisting of an interventional cardiologist, an echocardiographer-cardiologist, a neurologist, and a radiologist) based on clinical data, echocardiographic findings, and patient preference. All patients (51 men, overall mean age 50 years) had a PFO of more than moderate grade, as assessed according to previous studies [ 11 , 12 ]. The Amplatzer ® PFO Occluder (St. Jude Medical, St. Paul, MN, USA), GORE ® Septal Occluder (WL Gore and Associates Inc., Newark, DE, USA), and Occlutech Figulla ® PFO Occluder (Occlutech GmbH, Jena, Germany) were implanted in all patients.…”

Section: Methodsmentioning

confidence: 99%

“…A shunt was defined as the appearance of contrast bubbles in the left atrium (LA) within three cardiac cycles of opacification of the right atrium (RA). Shunt degrees were defined as mild, moderate, and severe if 3–9, 10–30, and >30 contrast bubbles, respectively, appeared in the LA [ 11 , 12 , 13 ]. Shunt at rest was defined as the appearance of contrast bubbles in the LA within three cardiac cycles of RA opacification with normal respiration or presence of shunt flow on color Doppler [ 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…Shunt degrees were defined as mild, moderate, and severe if 3–9, 10–30, and >30 contrast bubbles, respectively, appeared in the LA [ 11 , 12 , 13 ]. Shunt at rest was defined as the appearance of contrast bubbles in the LA within three cardiac cycles of RA opacification with normal respiration or presence of shunt flow on color Doppler [ 11 , 12 ]. ASA was defined as interatrial septal excursion of ≥10 mm from the midline during the cardiac cycle [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

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Comparison of Intracardiac Echocardiography and Transesophageal Echocardiography for Image Guidance in Percutaneous Patent Foramen Ovale Closure

Moon

Park

et al. 2020

Medicina

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Background and Objectives: Transesophageal echocardiography (TEE) guidance is the current gold standard for catheter-based procedures in the treatment of structural heart diseases. Intracardiac echocardiography (ICE), which can be performed under local anesthesia, has been recently introduced and is becoming more widely used. We aimed to compare the efficacy and safety of ICE and TEE in patent foramen ovale (PFO) device closure. Materials and Methods: All 74 patients with a history of cryptogenic stroke undergoing PFO closure for secondary prophylaxis were selected from our registry. Intraprocedural TEE was performed by echocardiographer-cardiologists with the patient under general anesthesia. Conversely, ICE was performed with the patient under local anesthesia. Baseline characteristics, procedural details, and immediate outcomes were compared between the TEE and ICE groups (n = 49 and n = 25, respectively). Results: Although patients in the ICE group were older (47 ± 10 vs. 57 ± 7 years, p < 0.001), sex and comorbidity variables were similar between the two groups. The degree of inducible right-to-left shunt via the PFO, assessed using preprocedural TEE, was also comparable. Notably, fluoroscopy time (22 ± 18 vs. 16 ± 7 min, p = 0.030), radiation dose (498 ± 880 vs. 196 ± 111 mGy, p = 0.022), and total procedural time in the catheter laboratory (99 ± 30 vs. 67 ± 12 min, p < 0.001) were significantly lower in the ICE group than those in the TEE group. The entire hospital stay was similar between groups (3.8 ± 2.2 vs. 3.4 ± 1.3 days, p = 0.433). No procedural complications, such as device embolization, pericardial hemorrhage, major bleeding, mortality, or access-related vascular injury were reported in either group. Conclusions: ICE-guided PFO device closure is quicker and less hazardous in terms of radiation exposure than the TEE-guided procedure, with similar procedural outcomes and duration of hospital stay.

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Comparison of Outcomes after Device Closure with Transseptal Puncture and Standard Technique in Patients with Patent Foramen Ovale and Ischemic Events

Abstract: Compared to the standard technique, PFO closure with the transseptal puncture technique showed higher incidence of residual shunt and ischemic events. Therefore, this technique might be considered in only highly selected patients as the last option.

Cited by 7 publications

References 17 publications

Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Effect of patent foramen ovale closure for prevention on recurrent stroke or transient ischemic attack in selected patients with cryptogenic stroke

Comparison of Intracardiac Echocardiography and Transesophageal Echocardiography for Image Guidance in Percutaneous Patent Foramen Ovale Closure

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