Hazards of percutaneous PFO closure

Abstract

Please see the article by Christen et al. (doi: 10.1016/j.euje.2005.08.002 ) to which this editorial pertains. In 2004, an estimated 2000–3000 patients underwent percutaneous closure of a patent foramen ovale (PFO). Given the range of potential indications (such as prevention of cryptogenic stroke, decompression illness in divers, platypnea–orthodeoxia syndrome, and migraine headaches) and the perception of PFO closure being an easy and safe procedure,1 the number of patients with percutaneously implanted PFO closure devices will continue to grow. The first attempt to percutaneously close an interatrial defect was undertaken in 1974 and reported by King and colleagues in 1976.2 In the following years, several different devices were developed and re-modified to facilitate this technique. It began with the Clamshell occluder from Rashkind,3 later modified into the CardioSEAL and then the StarFLEX device. Other models soon followed including the Buttoned device,4 the ASDOS device,5 the Monodisk,6 the Angel-Wings device,7 the Amplatzer ASD occluder8 and the Helex device.9 Although these devices were initially intended for atrial septal defect closure, they could also be used for closure of PFO, an idea first evoked by Bridges in 1992.10 Soon thereafter, devices dedicated exclusively for percutaneous PFO closure entered the market, namely the Amplatzer PFO occluder and the PFOStar (now Cardiastar) device. Part of the reasoning to favour percutaneous PFO closure over open heart surgery promises a safer and of course, less …