Safety and feasibility of day case patent foramen ovale (PFO) closure facilitated by intracardiac echocardiography

Background: Transcatheter Patent Foramen Ovale (PFO) is recommended as a therapy in secondary prevention of cryptogenic stroke. The aim of this study was to report one-year French single-center experience in PFO closure under sole Transthoracic Echocardiography (TTE) and fluoroscopy guidance performed as a day-case procedure versus a 3-day hospitalization. Methods: In 2018, all consecutive patients undergoing PFO closure for stroke were retrospectively included: 108 patients as a day-case procedure (group 1) versus 20 patients performed under a 3-day hospitalization (group 2). A comparison was performed between Occlutech and Amplatzer PFO devices and the impact on hospitalization costs was studied. Results: Occluders included Occlutech (n=81), Amplatzer (n=43), Lifetech (n=2) and PFM (n=2) PFO devices. Implantation succeeded in all. In-group 1, hospital discharge was delayed in only 3 cases. At one-month, 5 patients had Atrial Fibrillation (AF) and 91 patients (84%) had no residual shunt. In-group 2, hospital discharge was delayed in 4 patients. At one month, 1 patient had AF and no shunt was observed in 80%. In the comparative study, no significant statistical difference could be observed between Amplatzer and Occlutech devices. The one-day strategy leaded to a positive balance of 1825 euros per procedure in 2018, with a difference of 3785 euros with group 2. Conclusion: Our experience suggests that day-case PFO closure under fluoroscopy and TTE guidance is safe and effective in the majority of patients leading to a cost reduction and no increased risk of embolization.

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Day Case Patent Foramen Ovale Closure Facilitated by Intracardiac Echocardiography: The Oxford Experience

Heart Lung and Circulation ◽

10.1016/j.hlc.2007.06.377 ◽

2007 ◽

Vol 16 ◽

pp. S151 ◽

Cited By ~ 2

Author(s):

F.A. Ponnuthurai ◽

W.J. van Gaal ◽

A. Burchell ◽

O. Ormerod

Keyword(s):

Patent Foramen Ovale ◽

Intracardiac Echocardiography ◽

Foramen Ovale ◽

Day Case

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Short- and long-term haemodynamic consequences of transcatheter closure of atrial septal defect and patent foramen ovale

Netherlands Heart Journal ◽

10.1007/s12471-021-01543-0 ◽

2021 ◽

Author(s):

X. Jin ◽

Y. M. Hummel ◽

W. T. Tay ◽

J. F. Nauta ◽

N. S. S. Bamadhaj ◽

...

Keyword(s):

Atrial Septal Defect ◽

Diastolic Function ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Transcatheter Closure ◽

Foramen Ovale ◽

Short And Long Term ◽

Interatrial Shunt ◽

Pfo Closure

Abstract Background Transcatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure might have opposite short- and long-term haemodynamic consequences compared with restricted interatrial shunt creation, which recently emerged as a potential treatment modality for patients with heart failure with preserved ejection fraction (HFpEF). Given the opposing approaches of ASD and PFO closure versus shunt creation, we investigated the early and sustained cardiac structural and functional changes following transcatheter ASD or PFO closure. Methods In this retrospective study, adult secundum-type ASD and PFO patients with complete echocardiography examinations at baseline and at 1‑day and 1‑year follow-up who also underwent transcatheter closure between 2013 and 2017 at the University Medical Centre Groningen, the Netherlands were included. Results Thirty-nine patients (mean age 48 ± standard deviation 16 years, 61.5% women) were included. Transcatheter ASD/PFO closure resulted in an early and persistent decrease in right ventricular systolic and diastolic function. Additionally, transcatheter ASD/PFO closure resulted in an early and sustained favourable response of left ventricular (LV) systolic function, but also in deterioration of LV diastolic function with an increase in LV filling pressure (LVFP), as assessed by echocardiography. Age (β = 0.31, p = 0.009) and atrial fibrillation (AF; β = 0.24, p = 0.03) were associated with a sustained increase in LVFP after transcatheter ASD/PFO closure estimated by mean E/e’ ratio (i.e. ratio of mitral peak velocity of early filling to diastolic mitral annular velocity). In subgroup analysis, this was similar for ASD and PFO closure. Conclusion Older patients and patients with AF were predisposed to sustained increases in left-sided filling pressures resembling HFpEF following ASD or PFO closure. Consequently, these findings support the current concept that creating a restricted interatrial shunt might be beneficial, particularly in elderly HFpEF patients with AF.

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Does persistent (patent) foramen ovale closure reduce the risk of recurrent decompression sickness in scuba divers?

Diving and Hyperbaric Medicine Journal ◽

10.28920/dhm51.1.63-67 ◽

2021 ◽

Vol 51 (1) ◽

pp. 63-67

Author(s):

Björn Edvinsson ◽

◽

Ulf Thilén ◽

Niels Erik Nielsen ◽

Christina Christersson ◽

...

Keyword(s):

Patent Foramen Ovale ◽

Decompression Sickness ◽

Foramen Ovale ◽

Residual Shunt ◽

Interatrial Communication ◽

Scuba Divers ◽

Increased Risk ◽

History Of ◽

Catheter Closure ◽

Pfo Closure

Introduction: Interatrial communication is associated with an increased risk of decompression sickness (DCS) in scuba diving. It has been proposed that there would be a decreased risk of DCS after closure of the interatrial communication, i.e., persistent (patent) foramen ovale (PFO). However, the clinical evidence supporting this is limited. Methods: Medical records were reviewed to identify Swedish scuba divers with a history of DCS and catheter closure of an interatrial communication. Thereafter, phone interviews were conducted with questions regarding diving and DCS. All Swedish divers who had had catheter-based PFO-closure because of DCS were followed up, assessing post-closure diving habits and recurrent DCS. Results: Nine divers, all with a PFO, were included. Eight were diving post-closure. These divers had performed 6,835 dives (median 410, range 140–2,200) before closure, and 4,708 dives (median 413, range 11–2,000) after closure. Seven cases with mild and 10 with serious DCS symptoms were reported before the PFO closure. One diver with a small residual shunt suffered serious DCS post-closure; however, that dive was performed with a provocative diving profile. Conclusion: Divers with PFO and DCS continue to dive after PFO closure and this seems to be fairly safe. Our study suggests a conservative diving profile when there is a residual shunt after PFO closure, to prevent recurrent DCS events.

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Patient with systemic emboli in the setting of Klebsiella oxytoca tricuspid valve endocarditis and patent foramen ovale treated with NobleStitch and AngioVac

BMJ Case Reports ◽

10.1136/bcr-2021-243370 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243370

Author(s):

John Leso ◽

Majd Al-Ahmad ◽

Drinnon O Hand

Keyword(s):

Tricuspid Valve ◽

Patent Foramen Ovale ◽

Klebsiella Oxytoca ◽

Signs And Symptoms ◽

Foramen Ovale ◽

Surgical Debulking ◽

History Of ◽

Infectious Disease Specialists ◽

High Index Of Suspicion ◽

Pfo Closure

A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.

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Is Migraine Associated with Right-to-Left Shunt a Separate Disease? Results of the SAM Study

Cephalalgia ◽

10.1111/j.1468-2982.2008.01539.x ◽

2008 ◽

Vol 28 (4) ◽

pp. 360-366 ◽

Cited By ~ 24

Author(s):

GP Anzola ◽

G Meneghetti ◽

C Zanferrari ◽

A Adami ◽

L Dinia ◽

...

Keyword(s):

Family History ◽

Observational Study ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Genetic Linkage ◽

Personal History ◽

Coagulation Disorders ◽

Foramen Ovale ◽

History Of ◽

Pfo Closure

Migraine with aura (MA) is associated with the persistence of patent foramen ovale (PFO) in about 50% of cases, and migraineurs tend to have larger shunts than controls, suggesting that right-to-left shunt (RILES) determined by PFO could play a role in triggering migraine attacks. Moreover, some preliminary reports have suggested that PFO closure may give relief to both migraine and aura attacks. The aim of this study was to clarify if shunt-associated migraine (SAM) has clinical features that allow a distinction from shunt-unrelated migraine (SUM), in a prospective, multicentre, observational study (SAM study). We enrolled consecutive MA patients, who underwent a structured, standardized questionnaire for family and personal history and for detailed migraine features. All were systematically screened for RILES with transcranial Doppler, and for coagulation disorders. Overall, 460 patients were included; the SUM and SAM classes comprised 58% and 42% of patients, respectively. SAM patients were significantly younger (34.1 ± 10 vs. 37.1 ± 11 years), had a more frequent family history of migraine (76% vs. 66%) and a higher frequency of sensory symptoms of aura (51% vs. 41%); by contrast, there was a lesser association of SAM with other cardiac abnormalities and with coagulation disorders. The SAM study suggests that the effect of RILES on migraine features is not relevant. The higher family history of migraine in SAM suggests a possible genetic linkage between migraine and RILES.

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Patent Foramen Ovale Closure Versus Medical Therapy in Cryptogenic Strokes and Transient Ischemic Attacks: A Meta-Analysis of Randomized Trials

Angiology ◽

10.1177/0003319718802635 ◽

2018 ◽

Vol 70 (4) ◽

pp. 325-331 ◽

Cited By ~ 5

Author(s):

Simone Vidale ◽

Filippo Russo ◽

Carlo Campana ◽

Elio Agostoni

Keyword(s):

Medical Treatment ◽

Patent Foramen Ovale ◽

Transcatheter Closure ◽

Meta Analysis ◽

Cochrane Library ◽

Transient Ischemic Attacks ◽

Foramen Ovale ◽

End Points ◽

Pfo Closure ◽

New Onset

Cryptogenic strokes account for about 25% to 40% of total ischemic strokes, and 1 of the 3 of these have a patent foramen ovale (PFO). A meta-analysis concerning the effectiveness and safety of PFO closure in cryptogenic strokes or transient ischemic attacks (TIAs) was performed. We systematically searched Medline, Embase, and the Cochrane Library through April 2018. Eligible studies were randomized clinical trials. Primary and secondary end points were, respectively, stroke or TIA and stroke recurrences. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for all end points using fixed- and random-effects meta-analyses. Data were included from 6 trials involving 3560 patients. In the pooled analysis, PFO closure was superior to medical treatment for both primary (RR: 0.39; 95% CI: 0.18-0.82; P < .02) and secondary end points (RR: 0.58; 95% CI: 0.44-0.76; P < .001). Transcatheter closure significantly increased the risk of new-onset atrial fibrillation (AF; RR: 5.74; P < .001). Percutaneous closure is superior to medical treatment in reducing stroke and TIA recurrence, even if with a significant risk increasing for new-onset AF. These findings suggest that transcatheter closure is indicated in patients with cryptogenic strokes and large PFO.

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Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-1042-4 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Yangyang Han ◽

Xiquan Zhang ◽

Fengwei Zhang

Keyword(s):

Body Weight ◽

Contrast Agents ◽

Transesophageal Echocardiography ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Percutaneous Closure ◽

X Rays ◽

Foramen Ovale ◽

Pfo Closure

Abstract Background Percutaneous closure of patent foramen ovale (PFO) is routinely performed using plain fluoroscopy in the catheter room. This method results in inevitable radiation damage, adverse effects of contrast agents on kidneys, and high cost. We performed PFO closure with a simplified and economical transesophageal echocardiography (TEE)-only guided approach in the operating room. This study aimed to investigate the feasibility, safety, and effectiveness of the percutaneous closure of PFO by only using TEE. Methods We reviewed the medical records of patients who underwent percutaneous PFO closure at our center from December 2013 to December 2017. A total of 132 patients with PFO and cryptogenic strokes underwent PFO closure by using cardi-O-fix PFO device under TEE guidance. The participants comprised 64 and 68 male and female patients, respectively. The mean age and body weight of the patients were 39.40 ± 13.22 years old (12–68 years old) and 65.42 ± 9.70 kg (40–95 kg), respectively. All patients only received aspirin (3–5 mg/kg body weight, oral administration) for 6 months. Contrast-enhanced transthoracic echocardiography (c-TTE) with Valsalva maneuver was performed during follow-up, and questionnaire surveys were obtained at 3, 6, and 12 months after the procedure. Results All (100%) patients were successfully closed. Follow-ups were conducted for 13 months to 48 months, with an average of 27 months. No severe complications were found during the follow-up period. Paroxysmal atrial fibrillation occurred in 4 patients within 3 months after the procedure. No recurrent stroke or death occurred in all patients during the follow-up period. Transient ischemic attack occurred in one patient 6 months after the procedure. Ten (7.6%) patients had a right-to-left shunt, as demonstrated by c-TTE at 12 months of follow-up. Among the 57 patients suffering from migraine, significant relief or resolution was reported by 42 (73.7%) patients. Conclusion TEE-only guided PFO closure was a safe, feasible, and effective method that did not require the use of X-rays and contrast agents.

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High-grade atrioventricular block occurring during percutaneous closure of patent foramen ovale: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa141 ◽

2020 ◽

Vol 4 (4) ◽

pp. 1-5

Author(s):

Marion Kibler ◽

Halim Marzak ◽

Laurence Jesel ◽

Patrick Ohlmann

Keyword(s):

Atrioventricular Block ◽

Patent Foramen Ovale ◽

Atrioventricular Node ◽

Percutaneous Closure ◽

Right Atrial ◽

Closure Device ◽

High Grade ◽

Foramen Ovale ◽

Conduction Disturbances ◽

Pfo Closure

Abstract Background Percutaneous closure of patent foramen ovale (PFO) is recommended for patients presenting with PFO-related stroke. Acute high-grade conduction disturbances occurring during PFO closure procedure have not been previously reported. Case summary We describe for the first time a case of reversible complete atrioventricular block which occurred during closure of a PFO. Discussion We hypothesized that the block was the result of atrioventricular node compression—likely caused by the right-atrial disc of the 35-mm PFO closure device. We suggest implanting smaller devices in order to prevent atrioventricular conduction disturbances.

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