Explantation of Patent Foramen Ovale Closure Devices

Verma, Swarnendra K.; Tobis, Jonathan M.

doi:10.1016/j.jcin.2011.01.009

Cited by 72 publications

(50 citation statements)

References 21 publications

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“…The study focused on the 38 patients who had device removal, of which 14 (37%) had chest pain as the indication for removal. Up to 17% of those patients had a nickel allergy 81. It is still unclear whether nickel allergy skin testing on patients with suspected hypersensitivity to nickel before device implant is warranted.…”

Section: Complications Of Pfo Closurementioning

confidence: 99%

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

Collado

Poulin

Murphy

et al. 2018

JAHA

101

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Section: Complications Of Pfo Closurementioning

confidence: 99%

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

Collado

Poulin

Murphy

et al. 2018

JAHA

101

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“…Of note, treatment with steroids and/or non-steroidal anti-inflammatory drugs should be attempted prior to device explantation. [75]. The migraines may respond to the anti-platelet agent, clopidogrel, but if the chest pain persists, it can only be relieved by surgical removal of the device [75].…”

Section: Safety Of Percutaneous Pfo Closurementioning

confidence: 99%

“…[75]. The migraines may respond to the anti-platelet agent, clopidogrel, but if the chest pain persists, it can only be relieved by surgical removal of the device [75]. [75].…”

Section: Safety Of Percutaneous Pfo Closurementioning

confidence: 99%

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Patent foramen ovale: Unanswered questions

Mojadidi

Christia

Salamon

et al. 2015

European Journal of Internal Medicine

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The foramen ovale is a remnant of the fetal circulation that remains patent in 20-25% of the adult population. Although long overlooked as a potential pathway that could produce pathologic conditions, the presence of a patent foramen ovale (PFO) has been associated with a higher than expected frequency in a variety of clinical syndromes including cryptogenic stroke, migraines, sleep apnea, platypnea-orthodeoxia, deep sea diving associated decompression illness, and high altitude pulmonary edema. A unifying hypothesis is that a chemical or particulate matter from the venous circulation crosses the PFO conduit between the right and left atria to produce a variety of clinical syndromes. Although observational studies suggest a therapeutic benefit of PFO closure compared to medical therapy alone in patients with cryptogenic stroke, 3 randomized controlled trials (RCTs) did not confirm the superiority of PFO closure for the secondary prevention of stroke. However, meta-analyses of these RCTs demonstrate a significant benefit of PFO closure over medical therapy alone. Similarly, observational studies provide support for PFO closure for symptomatic relief of migraines. But one controversial randomized study failed to replicate the results of the observational studies while another two demonstrated a partial benefit. The goal of this review is to discuss the clinical conditions associated with PFO and provide internists and primary care physicians with current data on PFO trials, and clinical insight to help guide their patients who are found to have a PFO on echocardiographic testing. Embryology and anatomySince fetal lungs in utero are incapable of oxygenating blood, the fetus is dependent on the maternal circulation for oxygen delivery via the placenta. Oxygenated blood returning to the right atrium via the umbilical vein needs to be delivered to the brain and vital organs before further loss of oxygen occurs. To facilitate this rapid transit, an inter-atrial communication evolved in all mammals, known as the foramen ovale [1].After birth, the foramen ovale flap (the septum primum) physiologically closes against the septum secundum when pulmonary vascular resistance and right atrial pressure decrease. An atrial septal aneurysm (ASA), a saccular deformity of the atrial septum that protrudes 15 mm in the direction of either atria, is associated with 15% of PFOs and is often seen with the largest size PFO [3] and [4]. PFO imagingThe most accurate test for determining the presence of a PFO is a right heart catheterization with documentation of a guidewire crossing the atrial septum. The standard non-invasive method for diagnosing a PFO is transesophageal echocardiography (TEE) using agitated saline contrast [5]. Transcranial Doppler (TCD) is a more sensitive and less uncomfortable method for diagnosing PFO with a sensitivity of 97% and specificity of 93% [6]. Transthoracic echocardiogram (TTE) with bubble study is a less expensive, non-invasive test compared to TEE with comparable specificity [7] and [8]. Howeve...

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“…The incidence of device-related infection in patients with normal immune systems who undergo closure is exceedingly rare. In a retrospective survey of PFO closure device explantation, only 38 devices were explanted for various reasons out of 13,736 cases (0.28%), with only one explanted due to endocarditis [1]. Some risk factors may predispose patients to greater risk of infection of a closure device, such as diabetes, renal failure, organ transplant, immunosuppressed state, or autoimmune disease.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Kar¹,

Aboulhosn²,

Tandar³

et al. 2017

jshd

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Background: Percutaneous closure devices for cardiac defects have been used with a high degree of efficacy and safety. However, patients with autoimmune disease or immunosuppression are excluded in clinical trials due to their presumed higher risk. Percutaneous closure of patent foramen ovale (PFO) or atrial septal defect (ASD) is safe in patients who are immunosuppressed or have autoimmune disease. Methods: A retrospective observational multicenter study was performed including 24 patients who were immunocompromised or had autoimmune disease from vasculitis, Human Immunodeficiency Virus, hepatitis, cancer, or renal transplant and underwent percutaneous PFO or ASD closure for cryptogenic stroke (9.38%), desaturation (5.21%), migraine (7.29%), or a combination of these diagnoses (3.13%). Post-procedure follow-up included clinical evaluation at 3-6 months or telephone questionnaire up to 8 years later. Results: Of the 24 patients who met inclusion criteria (53 ± 14 years of age, follow-up of 21 ± 28 months), 19 had a PFO (79%), 5 had an ASD (21%), and 21 (88%) underwent closure. There was no evidence of endocarditis, device erosion, exacerbation of migraine, or recurrent stroke. Only one patient (4%) experienced a transient neurologic deficit after closure due to complex migraine with visual aura. Mortality status, which was verified by the social security death index, showed five deaths related to non-cardiac conditions. Conclusion: This observational study of an uncommon condition suggests that percutaneous closure of a PFO or ASD is safe in immunocompromised patients.

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Explantation of Patent Foramen Ovale Closure Devices

Cited by 72 publications

References 21 publications

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

Patent foramen ovale: Unanswered questions

Percutaneous Atrial Septal Closure in Immunocompromised Patients

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