Patent Foramen Ovale and Left Atrial Appendage: New Devices and Methods for Closure

Abstract

Transcatheter closure of atrial septal defects (ASDs) has become a routine procedure in many countries of the world. It spares many patients cardiac surgery and has proven efficacy in long-term studies. Device improvements have resulted in a continuous reduction of complications and of residual shunt frequency. ASD closure devices are also used for transcatheter closure of patent foramen ovale (PFO) for prevention of paradoxical embolism. In the past few years, there has been increasing interest in developing devices specifically designed for PFO closure. Although transcatheter closure of ASDs is well established, interventional closure of the left atrial appendage is in its development stage. Closure of the left atrial appendage is designed to reduce the risk of stroke in patients with atrial fibrillation in whom anticoagulation with Warfarin-type drugs is contraindicated. This article describes the latest developments in catheter closure of PFO and the left atrial appendage.

Occluding the left atrial appendage: anatomical considerations

“…Other epicardial approaches using the stapling method have led to LAA tears 1 12. Alternative methods of LAA occlusion, such as the percutaneous approach to implant occluders, have developed in recent years with a range in designs of the devices 13. Ostermayer et al highlighted the potential advantages of this method over conventional surgical techniques, especially in patients in whom anticoagulation therapy is contraindicated 14.…”

“…The range of diameters in our study (10–24.1 mm) corresponds well with the range of sizes available for the occluders. These percutaneous devices/systems,13 however, have a round shape to fill or cover the os. A previous study9 and our study show that the shape of the os is consistently elliptical rather than round.…”

Recent development of transcatheter closure of atrial septal defect and patent foramen ovale with occluders

“…Metals (especially nitinol) are widely used in the occluders as frame material. The permanent presence of foreign nondegradable materials in vivo is not desirable since it could cause long‐term complications . Other related problems include perforation, friction lesion, atrial arrhythmia, erosion, and thromboembolism .…”

“…The permanent presence of foreign nondegradable materials in vivo is not desirable since it could cause long-term complications. 36 Other related problems include perforation, friction lesion, atrial arrhythmia, erosion, A(A(CH 2 ) 5 ACOOA) n A Poly(para-dioxanone)…”

Early Experience with a Simplified Technique for Transcatheter Closure of the Patent Foramen Ovale

“…Numerous subsequent reports have described the safety and efficacy of this procedure using a number of different devices and techniques [2][3][4][5][6]. Although reported complications associated with PFO closure are uncommon [2,3,7-9], serious complications such as the introduction of air or thrombus into the systemic circulation [10] and cardiac perforation [9,11] do occur.…”