Patent Foramen Ovale Closure

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Setting aside the controversial questions of whether closing a patent foramen ovale (PFO) is indicated or effective for the prevention of recurrent stroke or the treatment of migraine headaches, what is the physiological impact of implanting a transcatheter device in the atrial septum? In this issue of Circulation , Wohrle and his colleagues address 1 aspect of this question, reporting the results of a study in which they assessed atrioventricular and semilunar valve function in 102 patients before and after transcatheter PFO closure.1 The authors evaluated valvar competence before, the day following, and 12 months after PFO closure and found no significant change in aortic regurgitation (AR) or regurgitation of the other cardiac valves. On their own, these findings might be passed off as predictable and modestly novel. Viewed in the context of a recent article by Schoen et al in Heart , however, they are noteworthy.2 Accordingly, to appreciate the study by Wohrle et al fully, it should be read as a counterpoint to the report by Schoen et al, which was a surprise to many in its description of new or increased AR in 10% of 170 patients who underwent transcatheter closure of a PFO and 9% of 70 in whom a device was placed to close an atrial septal defect.2 Article see p 3002 Before simply accepting the apparently contradictory findings of these 2 studies, however, it is worth acknowledging several basic methodological differences. The first difference is the means by which valvar regurgitation was assessed. In contrast to Schoen et al, who evaluated valvar function with transesophageal echocardiography 3, 6, and 12 months after catheterization, Wohrle et al assessed the function of the aortic and other valves with cardiac magnetic resonance imaging. Schoen et al graded AR according to a standard ordinal scale, …