Background. The interpretation of residual shunts after implantation of different devices for patent foramen ovale (PFO) with different morphologies after cerebrovascular events due to paradoxical embolism is controversial. Methods. Transcatheter PFO closure was performed in 123 patients with a history of ≥1 paradoxical embolism using three different devices: Amplatzer (n=46), Figulla Occlutech (n=41) and Atriasept Cardia (n=36). PFO was a simple flap (S-PFO) in 59 patients and complex (C-PFO) in 64 patients. Complex PFO included isolated aneurysmal septum, long tunnel–type, presence of a small additional atrial septal defect, septum primum deviation, and prominent Eustachian valve. All patients were studied with contrast-enhanced transesophageal echocardiography (TEE) before interventional procedure and thereafter at 1 and 6 months and every 6 to 12 months in case of incomplete closure. Definite closure was confirmed in at least two consecutive studies. Results. The diameter of the occluder varied according to the size of the atrial septum and the size of PFO at the TEE examination prior to implantation. The closure rate between simple and complex PFO concerning all implanted occluders was significantly different (p=0.03). Devices of 25 mm or less had a better occlusion rate. The difference between the closure rate of S-PFO and C-PFO concerning each device type was significant (Amplatzer, p<0.01; Figulla, p<0.01; Atriasept, p<0.05). In two patients thrombi were detected in the six month TEE controls and in two patients the implantation of an adjunctive device was necessary for residual shunt. The mean follow up period was 3.1 years (median 2.3 years) with a re-event-rate of 0.6% per year. Overall, no relation to residual PFO shunting or thrombus formation was seen. There were no peri-interventional major complications. Conclusions. The PFO closure rate is dependent on septal anatomy more than occluder size and type. An adjunctive device may be necessary in selected cases.
Early, mid and long term echocardiographic results of percutaneous closure in simple and complex patent foramen ovale / Vitarelli, Antonino; Mangieri, Enrico; Tanzilli, Gaetano; Capotosto, Lidia; D'Angeli, Ilaria; Placanica, Attilio; Placanica, Giuseppe; Ashurov, Rasul. - In: CARDIOLOGY. - ISSN 0008-6312. - STAMPA. - 128(Suppl 1):(2012), p. 488. (Intervento presentato al convegno 19th World Congress on Heart Disease, The International Academy of Cardiology, Annual Scientific Sessions 2014 tenutosi a Boston, MA, USA nel July 25-28, 2014) [10.1159/000365062].
Early, mid and long term echocardiographic results of percutaneous closure in simple and complex patent foramen ovale.
Antonio Vitarelli
Writing – Review & Editing
;Enrico Mangieri;Gaetano Tanzilli;Lidia Capotosto;Ilaria D’Angeli;Attilio Placanica;
2012
Abstract
Background. The interpretation of residual shunts after implantation of different devices for patent foramen ovale (PFO) with different morphologies after cerebrovascular events due to paradoxical embolism is controversial. Methods. Transcatheter PFO closure was performed in 123 patients with a history of ≥1 paradoxical embolism using three different devices: Amplatzer (n=46), Figulla Occlutech (n=41) and Atriasept Cardia (n=36). PFO was a simple flap (S-PFO) in 59 patients and complex (C-PFO) in 64 patients. Complex PFO included isolated aneurysmal septum, long tunnel–type, presence of a small additional atrial septal defect, septum primum deviation, and prominent Eustachian valve. All patients were studied with contrast-enhanced transesophageal echocardiography (TEE) before interventional procedure and thereafter at 1 and 6 months and every 6 to 12 months in case of incomplete closure. Definite closure was confirmed in at least two consecutive studies. Results. The diameter of the occluder varied according to the size of the atrial septum and the size of PFO at the TEE examination prior to implantation. The closure rate between simple and complex PFO concerning all implanted occluders was significantly different (p=0.03). Devices of 25 mm or less had a better occlusion rate. The difference between the closure rate of S-PFO and C-PFO concerning each device type was significant (Amplatzer, p<0.01; Figulla, p<0.01; Atriasept, p<0.05). In two patients thrombi were detected in the six month TEE controls and in two patients the implantation of an adjunctive device was necessary for residual shunt. The mean follow up period was 3.1 years (median 2.3 years) with a re-event-rate of 0.6% per year. Overall, no relation to residual PFO shunting or thrombus formation was seen. There were no peri-interventional major complications. Conclusions. The PFO closure rate is dependent on septal anatomy more than occluder size and type. An adjunctive device may be necessary in selected cases.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
