Device closure of residual shunt after percutaneous closure of patent foramen ovale

Abstract

To summarise our experiences of device closure of residual shunt after transcatheter closure of patent foramen ovale (PFO). Since October 1997 implantation of a second closure device was attempted in 40 patients with a moderate or large residual shunt after implantation of a PFO closure device. The mean age of the patients was 51 years. Implantation of a second closure device was technically successful in 39/40 patients (98 %). The following devices were implanted: Premere (n=20), Amplatzer PFO (n=13), STARFlex (n=4), Helex (n=1), Angelwings (n=1). During a mean follow-up of 36+/-29 months complete closure was achieved in 27 patients (69 %). The remaining shunt was small in nine patients, moderate in one and large in two. One patient with a moderate and one patient with a large residual shunt received a third device. The third patient was sent to surgery. One patient died 21 days after implantation of a third closure device due to acute pericardial tamponade. No other complications occurred. Transcatheter implantation of a second closure device after PFO closure is feasible. Complete closure can be achieved in the majority of patients.