title: Use of balloon pull-through technique to assist in CardioSEAL device closure of patent foramen ovale.
abstract: CardioSEAL device closure of patent foramen ovale (PFO) has been advocated for the treatment of patients with cryptogenic stroke. Using the standard delivery technique, partial deployment of the CardioSEAL device can occur, especially in patients with a thick septum secundum and/or long PFO tunnel. We hypothesized that using a left atrial-to-right atrial balloon pull-through to make the septum primum incompetent would result in improved final device position regardless of septal thickness or tunnel length. Catheterization reports, cineangiograms, and transesophageal echocardiograms of 51 patients who underwent CardioSEAL device closure of PFO between March 2000 and August 2002 were retrospectively reviewed. Group 1 (n = 21) included patients with CardioSEAL placement using the standard technique and group 2 (n = 30) included patients with CardioSEAL placement using the balloon pull-through technique. There were no differences between the groups in terms of age (43.6 vs. 45.3 years; P = NS), weight (83.3 vs. 89.9 kg; P = NS), septum secundum thickness (6.4 vs. 7.0 mm; P = NS), PFO tunnel length (15.5 vs. 13.1 mm; P = NS), or device size. In group 1, 4/21 (19%) had partial deployment of the CardioSEAL device, while in group 2, no partial CardioSEAL deployment (0/30) was observed. No complications were associated with the balloon pull-through technique. We conclude that the left atrial-to-right atrial balloon pull-through technique is safe and may allow for better final position of the CardioSEAL device during PFO closure.
authors.affiliation: Division of Cardiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Chintala
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Turner
authors.forename: Stephanie
authors.initials: S
authors.lastname: Leaman
authors.forename: Edwin
authors.initials: E
authors.lastname: Rodriguez-Cruz
authors.forename: Joshua
authors.initials: J
authors.lastname: Wynne
authors.forename: Adam
authors.initials: A
authors.lastname: Greenbaum
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Forbes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D004867:Equipment Design / Q000295:instrumentation; D004869:Equipment Safety / Q000295:instrumentation; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome