title: Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events.
abstract: BACKGROUND
  Patients with a patent foramen ovale (PFO) and paradoxical embolism are at risk for recurrent thromboembolic events. This study investigated the long-term risk of recurrent thromboembolic events in patients with PFO and paradoxical embolism after percutaneous PFO closure.
  
  
  RESULTS
  Since 1994, a total of 80 patients with PFO and at least 1 paradoxical embolic event (transient ischemic attack [TIA], cerebrovascular accident [CVA], peripheral embolism) have undergone percutaneous PFO closure with 5 different devices. There were 30 women and 50 men, with a mean age of 52+/-12 years. Sixty patients had only a PFO, whereas 20 patients had both a PFO and an atrial septal aneurysm. The implantation procedure was successful in 78 patients (98%). During 5 years of follow-up (mean, 1.6+/-1.4 years; range, 0.1 to 5.0 years), the actuarial annual risk to suffer a recurrent thromboembolic event was 2.5% for TIA, 0% for CVA, 0.9% for peripheral emboli, and 3.4% for the combined end point of TIA, CVA, or peripheral embolism. A postprocedural shunt was a predictor of recurrent paradoxical embolism (RR, 4.2; 95% CI, 1.1 to 17.8; P=0.03). The risk for recurrent thromboembolic events in patients with both atrial septal aneurysm and PFO was not significantly increased compared with patients with only PFO (RR, 1.0; 95% CI, 0.2 to 4.7; P=0.95).
  
  
  CONCLUSIONS
  Percutaneous PFO closure appears to be a promising technique in the prevention of recurrent systemic thromboembolism in patients with a PFO after a first event. Prospective studies comparing percutaneous PFO closure with antithrombotic medications or surgery must define its therapeutic value.
authors.affiliation: Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Windecker
authors.forename: A
authors.initials: A
authors.lastname: Wahl
authors.forename: T
authors.initials: T
authors.lastname: Chatterjee
authors.forename: A
authors.initials: A
authors.lastname: Garachemani
authors.forename: F R
authors.initials: FR
authors.lastname: Eberli
authors.forename: C
authors.initials: C
authors.lastname: Seiler
authors.forename: B
authors.initials: B
authors.lastname: Meier
mesh_terms: D000206:Actuarial Analysis; D006328:Cardiac Catheterization; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000150:complications / Q000628:therapy*; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000628:therapy*; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000209:etiology*; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D019736:Prostheses and Implants; D012008:Recurrence; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013923:Thromboembolism / Q000453:epidemiology*