Impact of transcatheter closure of patent foramen ovale in the evolution of migraine and role of residual shunt

Abstract Background Transcatheter closure of patent foramen ovale (PFO) has been demonstrated to be superior to medical therapy in stroke prevention in selected patients. Beyond traditional permanent metallic devices, NobleStitch EL, a suture-based system, has been developed as a potential alternative. Case summary A 50-year-old man underwent transcatheter closure of PFO with mild interatrial septal bulging and tunnel-like morphology with a NobleStitch device. A transthoracic echocardiography performed immediately after PFO closure showed residual shunt (RS), which persisted unchanged at staged controls, due to the inability of the delivery system to capture both the septum primum and the septum secundum. A second procedure was performed with the implantation of a Figulla Flex II 27/30 mm device, with no RS detectable at control echocardiography. Discussion The NobleStitch device is interesting in its concept, but several pitfalls may be encountered during its deployment. Opposite to permanent metallic devices, RSs after the procedure are not expected to decrease over time and should be managed with a different approach.

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Role of atrial fibrillation after transcatheter closure of patent foramen ovale in patients with or without cryptogenic stroke

International Journal of Cardiology ◽

10.1016/j.ijcard.2009.05.035 ◽

2011 ◽

Vol 146 (1) ◽

pp. 17-21 ◽

Cited By ~ 13

Author(s):

Gabriele Bronzetti ◽

Cinzia D'Angelo ◽

Andrea Donti ◽

Luisa Salomone ◽

Alessandro Giardini ◽

...

Keyword(s):

Atrial Fibrillation ◽

Patent Foramen Ovale ◽

Transcatheter Closure ◽

Cryptogenic Stroke ◽

Foramen Ovale

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Second transcatheter closure for residual shunt following percutaneous closure of patent foramen ovale

EuroIntervention ◽

10.4244/eij-d-17-00061 ◽

2017 ◽

Vol 13 (7) ◽

pp. 858-866 ◽

Cited By ~ 10

Author(s):

Njomeza Susuri ◽

Slayman Obeid ◽

Mirjam Ulmi ◽

George Siontis ◽

Andreas Wahl ◽

...

Keyword(s):

Patent Foramen Ovale ◽

Transcatheter Closure ◽

Percutaneous Closure ◽

Foramen Ovale ◽

Residual Shunt

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Stroke Prophylaxis by Percutaneous Closure of Patent Foramen Ovale and Left Atrial Appendage

Interventional Cardiology Review ◽

10.15420/icr.2011.6.1.67 ◽

2011 ◽

Vol 6 (1) ◽

pp. 67

Author(s):

Antonio L Bartorelli ◽

Claudio Tondo ◽

◽

Keyword(s):

Left Atrial ◽

Patent Foramen Ovale ◽

Stroke Risk ◽

Left Atrial Appendage ◽

Cryptogenic Stroke ◽

Atrial Appendage ◽

Foramen Ovale ◽

Percutaneous Procedures ◽

Cerebrovascular Events

Innovative percutaneous procedures for stroke prevention have emerged in the last two decades. Transcatheter closure of the patent foramen ovale (PFO) is performed in patients who suffered a cryptogenic stroke or a transient ischaemic attach (TIA) in order to prevent recurrence of thromboembolic events. Percutaneous occlusion of the left atrial appendage (LAA) has been introduced to reduce stroke risk in patients with atrial fibrillation (AF). The role of PFO and LAA in the occurrence of cerebrovascular events and the interventional device-based therapies to occlude the PFO and LAA are discussed.

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Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

Cardiovascular & Hematological Agents in Medicinal Chemistry ◽

10.2174/1871525718666200203111641 ◽

2020 ◽

Vol 18 (2) ◽

pp. 135-150

Author(s):

Harsha S. Nagarajarao ◽

Chandra P. Ojha ◽

Archana Kedar ◽

Debabrata Mukherjee

Keyword(s):

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Narrow Channel ◽

Paradoxical Embolism ◽

Current Evidence ◽

Foramen Ovale ◽

The Right ◽

The Relationship ◽

Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

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Cardiac Magnetic Resonance Imaging and Transesophageal Echocardiography in Patients With Transcatheter Closure of Patent Foramen Ovale

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2006.03.036 ◽

2006 ◽

Vol 48 (2) ◽

pp. 322-329 ◽

Cited By ~ 40

Author(s):

Thorsten Nusser ◽

Martin Höher ◽

Nico Merkle ◽

Olaf C. Grebe ◽

Jochen Spiess ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Transesophageal Echocardiography ◽

Patent Foramen Ovale ◽

Transcatheter Closure ◽

Foramen Ovale ◽

Resonance Imaging

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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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