Patent Foramen Ovale with Paradoxical Embolism: Mid‐Term Results of Transcatheter Closure in 256 Patients

Abstract

The purpose of this study was to assess the safety and feasibility of percutaneous interventional closure of patent foramen ovale (PFO) with or without atrial septal aneurysm (ASA) in symptomatic patients. Between June 1999 and June 2002, we performed transcatheter closure of PFO in 256 consecutive symptomatic patients (female/male = 1.45; mean age 48 +/- 16 years; range 14-75): ischemic stroke (n = 101), transient ischemic attack (n = 144), peripheral and coronary arterial embolism (n = 17); multiple events (n = 23); platypnea-orthodeoxia syndrome (n = 2); refractory hypoxemia (n = 1); and migraine aura (n = 27). The implanted devices were an Amplatzer PFO Occluder (n = 248), a Gore-HELEX Septal Occluder (n = 4), and PFO STAR (n = 4). Most procedures (n = 176.69%) were done under two-dimensional intracardiac echocardiography (ICE) guidance alone; in the last 30 patients, 3D/4D ICE reconstruction (TomTec Imaging Systems) 6mbH was obtained. In 30 cases, ICE and contrast enhanced-TCD have been used simultaneously in the catheterization laboratory. The devices were placed correctly in all patients. Mean fluoroscopy time was 9.45 +/- 5 minutes (range = 2.5-35 minutes); mean procedural time was 57 +/- 21 minutes (range = 15-135 minutes). Total occlusion rate at follow-up (mean 19 months, range 1-33) was 98.1%. No significant recurrent neurological events were observed. Transcatheter closure of PFO with or without ASA is a safe and effective, minimally invasive procedure that ensures high closure rate and avoids life-long anticoagulation. Mid-term follow-up results appear favorable with respect to recurrent thromboembolic events.

Comorbid neuropathologies in migraine

“…The incidence of migraine with aura is about 50% in cryptogenic stroke patients who have a PFO, instead of the 12% found in the general population. Moreover, the closure of the PFO has been associated with suppression of migraine attacks [33,34].…”

High prevalence of patent foramen ovale in migraine with aura

“…Moreover, a closure of PFO in patients with transient cerebral ischaemia, suffering from MA, induced a dramatic improvement of MA episodes, suggesting that aura may be triggered by factors that reach the brain by escaping the lung's filter [8].…”

Long-term follow-up after closure of patent foramen ovale

“…Intraprocedural guidance by TOE [17][18][19] or intracardiac echocardiography [20,21] was not used in any case. However, all patients had undergone contrast TOE for initial diagnosis of PFO prior to the intervention.…”

“…As reported in previous publications by our group, we performed systematic coronary angiography in patients undergoing percutaneous PFO closure aged CARDIOVASCULAR MEDICINE -KARDIOVASKULÄRE MEDIZIN -MÉDECINE CARDIOVASCULAIRE 2016;19(1): [19][20][21][22][23][24] >50 in males and >60 in females. In this study, a rather high proportion of the examined patients (29%) presented with unsuspected coronary artery disease, justifying incidental coronary angiography in selected patients.…”