title: Transcatheter closure of interatrial communications for secondary prevention of paradoxical embolism: single-center experience.
abstract: BACKGROUND
  Patients with a patent foramen ovale (PFO) after cerebral, coronary, or systemic embolic events of presumed paradoxical origin are at risk for recurrent thromboembolism. We report our single-center experience of interventional closure of interatrial communications for secondary prevention of presumed paradoxical embolism. Methods and Results- Since 1997, percutaneous closure of interatrial communications was performed at our institution in 66 patients (mean age 47.8+/-12.7 years; 31 males) with a PFO or an atrial septal defect and at least 1 documented presumed paradoxical thromboembolic event. Fifty-eight patients had cerebral embolism, 10 had coronary embolism, and 3 had peripheral embolism. Several patients experienced multilocal arterial embolism. Fifty-four patients had a PFO, 33 of them with an atrial septal aneurysm, and 12 had an atrial septal defect. The implantation procedure was successful and without complication in all patients. After 3 months, only 2 patients showed a residual shunt, which disappeared in both cases after 12 months. In 112.2 patient-years of follow-up (range, 5 weeks to 3.5 years), we have not seen any recurrent thromboembolic event.
  
  
  CONCLUSIONS
  Interventional closure of interatrial communications is a safe and effective therapeutic option for the secondary prevention of presumed paradoxical embolism. To further evaluate this strategy, randomized trials comparing interventional closure with anticoagulation have been initiated by us and others.
authors.affiliation: Unfallkrankenhaus Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.
authors.forename: Leonhard
authors.initials: L
authors.lastname: Bruch
authors.forename: Anne
authors.initials: A
authors.lastname: Parsi
authors.forename: Marc Oliver
authors.initials: MO
authors.lastname: Grad
authors.forename: Sascha
authors.initials: S
authors.lastname: Rux
authors.forename: Telse
authors.initials: T
authors.lastname: Burmeister
authors.forename: Heike
authors.initials: H
authors.lastname: Krebs
authors.forename: Franz Xaver
authors.initials: FX
authors.lastname: Kleber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D019320:Embolism, Paradoxical / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants