Echocardiographic findings in simple and complex patent foramen ovale before and after transcatheter closure

Aims. Percutaneous closure of patent foramen ovale (PFO) in cryptogenic cerebrovascular events is an alternative to medical therapy. The interpretation of residual shunts after implantation of different devices for PFO with different morphologies is controversial. Methods and results. 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). Fifty-six patients presented with simple PFO and 67 patients had complex morphologies. 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 TEE studies. Various PFO morphologies were identified by TEE before device implantation. The device size to PFO diameter ratio was significantly increased in patients with complex PFO compared to those patients with a simple PFO morphology (p<0.05). The difference between the closure rate of S-PFO and C-PFO concerning each device type was significant (Amplatzer p=0.0027, Figulla p=0.0043, Atriasept p<0.01). The mean follow up period was 3.4 years (median 2.7 years) with a cerebrovascular re-event-rate of 2.4% per year. In three patients thrombi were detected in the six month TEE controls and resolved after medical therapy. In three other patients the implantation of an adjunctive device was necessary for residual shunt. Conclusion. In our series of patients the closure rate was dependent on PFO morphology more than occluder size and type. An adjunctive device was implanted in selected cases.