Percutaneous Patent Foramen Ovale Research Articles

Feasibility, efficacy and safety of PFO closure under local anesthesia with transoesophageal echocardiography microprobe: A single-center study of 383 patients

Percutaneous patent foramen ovale (PFO) closure is usually performed under general anesthesia (GA) with guidance by transesophageal echocardiograpy (TEE). Microrobe makes this procedure possible under local anesthesia (LA). Our study aimed to assess the feasibility, efficacy and safety of PFO closure under LA with microprobe guidance. The aim was to evaluate the rate of PFO closure failure in patients who underwent a procedure under LA with a TEE microprobe (micro-LA group) vs. under GA with a conventional probe (conventional-GA group). The primary endpoint was the persistence of inter-atrial shunt (> 10 microbubbles) 6 months after procedure, screened by contrast transthoracic ultrasound. The secondary objectives were: identification of risk markers for the persistence of inter-atrial shunt at 6 months, post-procedure complication rates and major cardiovascular events rate. Three hundred and eighty three patients were included: 303 (79%) in the conventional-GA group, 79 (21%) in the micro-AL group. The median follow-up was 28.0 (14.0–49.0) months. The average age was 49.9 ± 12.6 years, 61.9% of men. There was no failure of PFO closure under AL. Six months after PFO closure, there was no difference in persistence of inter-atrial shunt between the conventional-GA group and the micro-AL group (29.3% vs. 25.5%, P = 0.583). There was no difference in the occurrence of complications related to the procedure between the 2 groups. In multivariate analysis, the presence of interatrial septal aneurysm [OR 1.88 (95% CI 1.07–3.31), P = 0.029], ROPE score > 6 [OR 1.22 (1.04–1.43), P = 0.015] and the occurrence of stroke following the procedure [OR 4.48 (1.12–17.87), P = 0.034] were independently associated with the presence of a residual inter-atrial shunt at 6 months. Our study identified that PFO closure under LA with TEE microprobe is feasible and safe. There was no difference in efficacy of 6-month FOP closure, regardless of conventional-GA or micro-AL method.

Analysis of Risk Factors Related to the Efficacy of Foramen Ovale Closure as a Therapy for Migraine.

This study aimed to monitor the incidence of migraine non-remission after percutaneous patent foramen ovale (PFO) closure and to discuss relevant risk factors. Recently, evidence of a relationship between the presence of PFO and migraines has been found, and PFO closure has been pointed out as a possible treatment for migraineurs.A retrospective analysis was conducted, which involved 139 patients diagnosed with PFO and associated migraine who underwent percutaneous PFO closure in The First Affiliated Hospital of Zhengzhou University from October 2019 to April 2021. All the considered patients were evaluated using the Headache Impact Test (HIT-6™) and classified with a score higher than 55 points before closure. The HIT-6™ score was re-evaluated 1-6 months after the intervention. HIT-6™ ≤ 55 was defined as headache remission (n = 93) and > 55 as headache non-remission (n = 46). A logistic regression model was developed to identify the risk factors of headache non-remission after PFO closure.The incidence of headache non-remission after PFO closure was 33.09%. Statistically significant differences were observed between the two groups as regards age and serum phosphorus level (P < 0.05). History of smoking, atrial fibrillation, absolute lymphocyte count, platelet-to-lymphocyte ratio, and interventricular septal thickness were identified as independent risk factors for headache non-remission following PFO closure, which were statistically significant (P < 0.05).

Falência do Dispositivo Noblestitch após Encerramento Percutâneo de Foramen Ovale Patente em um Caso de Síndrome de Platipneia-Ortodeoxia: Será Este Dispositivo para Todos os Doentes?

O forame oval patente (FOP) é uma lesão cardíaca congênita comum, correspondendo a uma comunicação interatrial fetal normal que tipicamente fecha com a fusão do septum primum ao septum secundum após o nascimento. Quando persiste, o forame oval geralmente é assintomático e benigno, sem necessidade de tratamento. Em casos raros, pode ter implicação na patogênese de algumas doenças como a síndrome de platipneia-ortodeóxia (SPO). Nesse contexto, pode ser indicado o fechamento do FOP. Vários dispositivos de oclusão tradicionalmente baseados em disco duplo demonstraram que o fechamento percutâneo do FOP é possível. Apesar da eficácia comprovada, o uso destes dispositivos não é tecnicamente viável para alguns pacientes. Além disso, eles têm o potencial de causar algumas complicações. NobleStitch EL (NS) é uma técnica alternativa de fechamento percutâneo do FOP disponível na Europa, com marcação comissão europeia (CE) para sutura cardiovascular e fechamento de FOP, e nos EUA, com liberação da Food and Drug Administration (FDA) para sutura vascular e cardiovascular. Consiste em um sistema “sem dispositivos” com dois cateteres dedicados para colocação de sutura. , Até o momento, a experiência com o dispositivo NS é limitada e ainda faltam informações sobre determinantes de falha, o que ajudaria na seleção de pacientes.

Noblestitch Failure After Percutaneous Patent Foramen Ovale Closure in a Case Of Platypnea-Orthodeoxia Syndrome: Is this Device Suitable for All Patients?

Noblestitch Failure After Percutaneous Patent Foramen Ovale Closure in a Case Of Platypnea-Orthodeoxia Syndrome: Is this Device Suitable for All Patients?

Correlation between percutaneous patent foramen ovale closure and recurrence of unexplained syncope.

The relationship between patent foramen ovale (PFO) and unexplained syncope remains to be illustrated. Therefore, this study aimed to explore the outcomes and prognostic factors for syncope recurrence after PFO closure. Patients with both large right-to-left shunting (RLS) PFO and unexplained syncope who visited the cardiovascular department of Xiangya Hospital Central South University from 1 January 2017 to 31 December 2021 were consecutively enrolled in our study. The recurrence rate of syncope was compared between the non-closure group (n = 20) and the closure group (n = 91). A total of 111 patients were finally included. After 31.11 ± 14.30 months of follow-up, only 11% of patients in the closure group had recurrent syncope, which was much lower than that of the non-closure group (11.0 vs. 35%, P = 0.018). We further investigated the possible prognostic factors for syncope recurrence in the closure group and found syncope occurring more than five times preoperatively, hypertension, and residual RLS at 12-month follow-up were significantly correlated with a higher number of recurrences. PFO closure reduced the recurrence rate of unexplained syncope. The efficacy of prevention was prognosticated by factors including the presence or absence of syncope induction, the frequency of syncope episodes, and the presence or absence of hypertension. Syncope recurrence was also related to residual shunts post closure.

Assessment of clinical outcomes after percutaneous patent foramen ovale closure in adult patients diagnosed with cryptogenic stroke

Assessment of clinical outcomes after percutaneous patent foramen ovale closure in adult patients diagnosed with cryptogenic stroke

Platypnea-Orthodeoxia Syndrome in an Elderly Patient Treated with Percutaneous Patent Foramen Ovale Closure: Report of a Case and Review of the Literature

Platypnea-Orthodeoxia Syndrome in an Elderly Patient Treated with Percutaneous Patent Foramen Ovale Closure: Report of a Case and Review of the Literature

Readmission in patients undergoing percutaneous patent foramen ovale closure in the United States

Current estimates suggest that a patent foramen ovale (PFO) may exist in up to 25% of the general population and is a potential risk factor for embolic, ischemic stroke. PFO closure complications include bleeding, need for procedure-related surgical intervention, pulmonary emboli, device malpositioning, new onset atrial arrhythmias, and transient atrioventricular block. Rates of PFO closure complications at a national level in the Unites States remain unknown. To address this, we performed a contemporary nationwide study using the 2016 and 2017 Nationwide Readmissions Database (NRD) to identify patterns of readmissions after percutaneous PFO closure. In conclusion, our study showed that following PFO closure, the most common complications were atrial fibrillation/atrial flutter followed by acute heart failure syndrome, supraventricular tachycardia and acute myocardial infarction.

TCT-316 Long Term Outcome of Percutaneous Patent Foramen Ovale Closure in Patients Above 60 Years Old

TCT-316 Long Term Outcome of Percutaneous Patent Foramen Ovale Closure in Patients Above 60 Years Old

Advances in Percutaneous Patent Foramen Ovale Closure: From the Procedure to the Echocardiographic Guidance.

Percutaneous patent foramen ovale (PFO) closure by traditional, double disc occluder devices was shown to be safe for patients with PFO, and more effective than prolonged medical therapy in preventing recurrent thromboembolic events. The novel suture-mediated “deviceless” PFO closure system overcomes most of the risks and limitations associated with the traditional PFO occluders, appearing to be feasible in most interatrial septum anatomies, even if data about its long-term effectiveness and safety are still lacking. The aim of the present review was to provide to the reader the state of the art about the traditional and newer techniques of PFO closure, focusing both on the procedural aspects and on the pivotal role of transesophageal echocardiography (TEE) in patient’s selection, peri-procedural guidance, and post-interventional follow-up.

Percutaneous Patent Foramen Ovale Closure in a Patient With Anomalous Aortic Origin of the Left Coronary Artery

Percutaneous Patent Foramen Ovale Closure in a Patient With Anomalous Aortic Origin of the Left Coronary Artery

P96 ACUTE CORONARY SYNDROME AND CORONARY ARTERY KINK

Abstract Coronary artery kink is a variant of anomalous coronary artery, not related to vessel disease. Often it is associated with coronary artery tortuosity (CAT) and fibromuscular dysplasia. The pathogenesis and clinical implications are not fully understood. Kinks are hypothesized to cause coronary blood flow alterations that can results in ischemia and even in acute coronary syndrome. It is speculated that coronary artery kinks are most often caused by guide wire straightening and seen after wiring the artery, but that is not always the case. We describe the case of a 55 years old woman, with familiar history of CAD. In 2019 she had percutaneous Patent Foramen Ovale closure intervention. She presented to the Emergency Department complaining chest pain radiating into the neck. The ECG was normal, but Troponin I levels were mildly elevated (2,1 ng/ml) and ipokinesia of basal and mid segment of the anterior intraventricular spetum was found at the ecoscopy. The patient was admitted to Cardiology department with diagnosis of unstable angina and urgent coronary angiography was performed. At a first glance the coronary arteries did not exhibit significant arteriosclerotic or thrombotic changes. However, upon a closer review, a focal kink of the mid left descending coronary artery was found. This coronary kink folded the LAD during systole causing a transient stenosis that resolved during diastole. Management of coronary kinks is controversial. In the past, literature suggested treatment with coronary stenting as one of the management options. However there are reported cases of adverse outcomes, such as shifting of kink proximally, requiring an additional stenting. We decided to treat patient with medical approach: beta–blockers at the tolerated doses was initiated, in addition to ACE–Inibithor, Aspirin and statin. Stenting of the coronary artery was not a choice, due to the possibility of shifting (as described in literature) and stent fracture. At a one month follow up the patient presented asymptomatic for angina, palpitation or dyspnea. Even if rarely coronary artery kink is a potential cause of myocardial ischemia and its treatment is often challenging to improve patient quality of life and to prevent adverse cardiac event.

D-48 | Optimal Duration of Dual Anti-Platelet Therapy after Percutaneous Patent Foramen Ovale and Atrial Septal Defect Closure

The AHA/ASA recommend PFO closure in patients with cryptogenic stroke (CS) and ASD closure for patients with a shunt resulting in RA/RV enlargement. Clinical efficacy and safety for closure has been well documented. Current guidelines suggest 6 months of dual anti-platelet therapy (DAPT) to prevent device thrombosis. However, data on the optimal duration of DAPT post device placement remains sparse.

A systematic transoesophageal echocardiography study of suture-mediated percutaneous patent foramen ovale closure.

A systematic transoesophageal echocardiography study of suture-mediated percutaneous patent foramen ovale closure.

Patent Foramen Ovale Closure for Treating Migraine: A Meta-Analysis.

Background Observational studies have shown percutaneous patent foramen ovale (PFO) closure to be a safe means of reducing the frequency and duration of migraine. Objective This study evaluated the efficacy and safety of PFO closure in patients with migraine using evidence-based medicine. Methods The Pubmed (MEDLINE), Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs), cohort studies, and retrospective case series from January 1, 2001, to February 30, 2021. The Jadad scale and R 4.1.0 software were used to assess the quality of the literature and meta-analysis, respectively. Results In total, three randomized controlled trials, one pooled study, and eight retrospective case series including 1,165 participants were included in the meta-analysis. Compared with control intervention in migraine, PFO closure could significantly reduce headache frequency (OR = 1.5698, 95% CI: 1.0465–2.3548, p=0.0293) and monthly migraine attacks and monthly migraine days (OR = 0.2594, 95% CI: 0.0790–0.4398, p=0.0048). Subgroup analysis of patients who all completed PFO surgery showed resolution of migraine headache for migraines with aura (OR = 1.5856, 95% CI: 1.0665–2.3575, p=0.0227). Conclusions Treatment with PFO closure could reduce the frequency of headaches and monthly migraine days and is an efficient treatment for migraine attacks with aura.

Abstract TP98: Diagnostic Utility Of Transcranial Color Flow Imaging Identifying High Risk Patent Foramen Ovale

Background and Purpose: Recent several studies demonstrated that percutaneous patent foramen ovale (PFO) closure reduced the risk of stroke recurrence for patients with cryptogenic stroke and PFO. Our aim of this retrospective study is to evaluate the usefulness of transcranial color flow imaging (TC-CFI) in the diagnosis of anatomically high risk PFO, in which percutaneous PFO closure is expected to be more effective in preventing embolism. Methods: Subjects were ischemic stroke patients who were investigated the presence of right-to-left shunt (RLS) using TC-CFI and transesophageal echocardiography (TEE). Anatomically high risk PFO evaluated by TEE were defined as satisfying one or more of the following findings: 1) large shunt (more than 20 microbubbles (MB) identified in the left ventricular system), 2) atrial septal aneurism, and 3) the presence of shunt without Valsalva maneuver (VM). TC-CFI was performed in the middle cerebral artery and/or intracranial vertebral artery once without VM and three times with VM, respectively. The number of microembolic signals from MB was determined using international Consensus Criteria (ICC). The accuracy of TC-CFI for high risk PFO diagnosed by TEE was calculated, and then the positive rate of TC-CFI in detecting high risk PFO was also analyzed by TC-CFI’s findings (A: ICC grade II or higher, B: positive without VM, and C: positive on multiple times or in multiple vessels). Results: We analyzed 176 patients (41 females, mean age 64 years) admitted to our facility from July 2019 to July 2021. Of them, 44 patients (25%) had PFO, and 29 patients (16%) were high risk. The diagnostic power of TC-CFI was sufficient, with sensitivity of 93%, specificity of 80%, and accuracy of 89%. The positive rate of each finding was significantly higher in C than in A and B (A: 23%, B: 39%, and C: 55%. P=0.04). Conclusions: To perform the TC-CFI procedure frequently in multiple vessels is useful for screening of high risk PFO.

Percutaneous Patent Foramen Ovale Closure in Patients with Cryptogenic Stroke or Transient Ischemic Attack: A Retrospective Study.

Background Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS). Transcatheter closure of PFO is superior to pharmacotherapy for patients with CS or transient ischemic attack (TIA). More evidence is needed to evaluate the efficacy and safety of PFO closure in Chinese patients. Methods This study enrolled ten CS patients and two TIA patients (mean age of 40.8 ± 9.7 y), including seven males (58%) and five females (42%) who underwent PFO closure in our center from January 2017 to July 2019. Baseline data, imaging data, and RoPE (Risk of Paradoxical Embolism) score were collected retrospectively. The preprocedural assessment and percutaneous transcatheter PFO closure were described in detail. The perioperative complications and follow-ups were recorded from all patients. Results Among ten patients with CS, eight patients had a RoPE score of >6 and two patients had a RoPE score of 6. MRI confirmed multiple infarcts in seven cases, and infarct involving the cortex in nine cases. Abnormal ECG was found in three patients and abnormal Echo in four patients. Right-to-left shunt (RLS) was detected in all the patients by cTCD or cTTE. To be specific, RLS was observed in nine of the ten TEE-detected patients. No case had PFO complicated with atrial septal aneurysm (ASA). The success rate of PFO closure was 91.6%. No serious perioperative complications were observed. During a mean time of 26.5 ± 8 months (15-41 months) of follow-up, no recurrent cerebral infarction, TIA, or thromboembolism were detected in postoperative patients. Conclusions PFO closure is safe and effective in the treatment of Chinese patients with CS or TIA.

Percutaneous Patent Foramen Ovale Closure After Stroke.

Percutaneous patent foramen ovale (PFO) closure in patients with a prior PFO-associated stroke showed a risk reduction of the stroke recurrence compared to the medical therapy alone in recent several studies. Nevertheless, optimal patient selection for PFO closure has not been clarified. In this paper, we discuss the characteristics of PFO-associated strokes and discuss the recently published evidence and patient selection for PFO closure in patients with ischemic stroke. The lesions characteristics of PFO-associated stroke are associated with multiple scattered lesion, small sized cerebral cortical lesion, or posterior circulation. Overcoming the failure of early studies in CLOSURE I, PC, and RESPECT trials, PFO closure showed a significant reduction in recurrent stroke in recently published REDUCE, CLOSE, DEFENSE-PRO trials, and long-term follow-up data of RESPECT study. However, considering that PFO closure cannot completely prevent stroke recurrence and that complications including atrial fibrillation, we should be selectively performed in patients with high-risk PFO.

Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: A prospective study.

Increased risk of new-onset atrial fibrillation (AF) after patent foramen ovale (PFO) closure was observed in randomized trials without however systematic AF screening. We aimed to evaluate the incidence of AF within 6-month following PFO closure with serial 24-hour ambulatory electrocardiogram (AECG) monitoring. All patients undergoing PFO closure were prospectively included in 2 centers. AF was defined as irregular rhythm without discernible P waves>30s on AECG at day 0, 1-month and 6-month follow-up. Primary endpoint was the incidence of AF within the study period. Secondary endpoints evaluated clinical outcomes within 6-month follow-up. Between February 2018 and March 2019, 62 patients underwent PFO closure including 40 male (64.5%) with a mean age of 48±9.5. Atrial septal aneurysm was observed in 37 patients (64.9%), 57 patients (91.9%) received an Amplatzer Occluder device (AbbottVascular) and 5 (8.1%) an Occlutech device (Occlutech). After a mean follow-up of 7.7±2.8months, new-onset AF occurred in 3 patients (4.8%), all within the first month following PFO closure, including one per-procedural, all were asymptomatic and paroxysmal. Two patients with AF (3.2%) required chronic oral anticoagulant therapy. No adverse outcomes occurred at follow-up. No predictive factors of AF were highlighted. A total of 16 patients (25.8%) reported palpitations without AF on the AECGs. In highly selected patients, incidence of AF, evaluated with 3 systematic 24-hour AECG within 6-month following PFO closure, was low (<5%). Always paroxysmal, AF occurred within the first month after the procedure and was not associated with adverse outcomes.

Coronary Artery Disease in Adults Undergoing Percutaneous Patent Foramen Ovale Closure Following Cryptogenic Stroke.

A patent foramen ovale (PFO) is found in nearly half of patients with cryptogenic stroke. Little guidance on the use or necessity of coronary angiography at the time of percutaneous PFO closure exists. We aimed to characterize the presence of coronary artery disease (CAD) in patients undergoing PFO closure following a cryptogenic stroke. A retrospective analysis of consecutive patients who underwent concurrent percutaneous PFO closure and coronary angiography was performed. Patients were ≥40 years of age and had a preceding diagnosis of cryptogenic stroke with no known CAD. Visual analysis of coronary angiograms was performed. Of 180 patients, 8 (4%) had severe CAD, 15 (8%) had moderate CAD, 32 (18%) had mild CAD, and 12 (7%) had luminal irregularities. Of those with moderate-to-severe CAD, 9 (5%) had proximal disease and 9 (5%) had multivessel disease. Of those with moderate-to-severe CAD, 8 (35%) underwent further risk stratification with stress testing, 4 (17%) were medically managed, and 1 (4%) underwent concurrent angioplasty. Coronary angiography identified a low prevalence of CAD in patients with cryptogenic stroke undergoing PFO closure, suggesting that coronary angiography is not routinely indicated in patients undergoing PFO closure.