Percutaneous closure of patent foramen ovale in patients with presumed paradoxical embolism: Periprocedural results and midterm risk of recurrent neurologic events

• Published in: The American heart journal 2008-08, Vol.156 (2), p.356-360
• Main Authors: Balbi, Manrico, MD, Casalino, Laura, MD, Gnecco, Giovanni, MD, Bezante, Gian Paolo, MD, FACC, Pongiglione, Giacomo, MD, Marasini, Maurizio, MD, Del Sette, Massimo, MD, Barsotti, Antonio, MD
• Format: Article
• Language: English
• Subjects: Adult; Anticoagulants; Biological and medical sciences; Cardiac Catheterization; Cardiology; Cardiology. Vascular system; Cardiovascular; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Embolism - etiology; Embolism - therapy; Embolism, Paradoxical - etiology; Embolisms; Female; Follow-Up Studies; Foramen Ovale, Patent - complications; Foramen Ovale, Patent - therapy; Heart; Humans; Ischemia; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - therapy; Male; Medical sciences; Medical treatment; Middle Aged; NMR; Nuclear magnetic resonance; Patients; Pneumology; Prostheses and Implants; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Respiratory system : syndromes and miscellaneous diseases; Statistical analysis; Stroke; Stroke - etiology; Stroke - therapy; Treatment Outcome
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2008.03.006

Objective To report our data on selected patients with previous paradoxical embolism who underwent transcatheter patent foramen ovale (PFO) closure. Methods Between July 2001 and July 2007, percutaneous PFO closure was performed on 128 patients (65 women, mean age: 46 ± 12.8 years). Patent foramen ovale closure was recommended for secondary prevention in patients with previous transient ischemic attacks (52.5%), stroke (46%), or peripheral embolism (1.5%). Results Implantation was successful in all patients, and at the end of intervention, complete PFO closure was achieved in 70.3% of them. There were no “major” complications (ie, deaths, device embolization or thrombosis, need for cardiac surgery). The overall incidence of complications (mostly hemorrhagic) was 7%. The mean follow-up period was 32 months. Complete closure had been achieved in 78.4% and in 82.5% of patients at the third month of transesophageal echocardiography examination and at the sixth month of transcranial Doppler examination, respectively. There were no recurrent thromboembolic events during the follow-up period. Conclusions Percutaneous closure of PFO is a feasible procedure, but it is not a risk-free technique. However, in correctly selected patients (ie, large PFO and those at risk for neurologic relapse), nearly complete PFO closure seems to provide protection from future neurologic ischaemic events at midterm follow-up.