title: Implantation of a second closure device in patients with residual shunt after percutaneous closure of patent foramen ovale.
abstract: Percutaneous closure of patent foramen ovale (PFO) in patients with presumed paradoxical embolism yields complete occlusion in > 90% of patients using contemporary closure devices. Patients with a residual shunt after percutaneous PFO closure have been found at increased risk for recurrent paradoxical events. Treatment options for such patients include medical treatment using antiplatelet drugs or oral anticoagulation, surgical device removal and patch closure, and percutaneous implantation of a second closure device. We report our experience with implantation of a second closure device in 10 patients with more than a minimal residual shunt < or = 6 months after percutaneous PFO closure. Procedure and fluoroscopy times were similar for the initial and repeat intervention (32 vs. 30 min and 5 vs. 6 min, respectively; P = NS). There were no procedural complications during implantation of the second closure device. Follow-up transesophageal echocardiography 6 months after the second percutaneous intervention revealed complete PFO closure in nine (90%) patients. Therefore, implantation of a second closure device in patients with persistence of more than a residual shunt after percutaneous PFO closure appears safe and effective.
authors.affiliation: Swiss Cardiovascular Center Bern, Cardiology, University Hospital, Bern, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Schwerzmann
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Andreas
authors.initials: A
authors.lastname: Wahl
authors.forename: Krassen
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Christian
authors.initials: C
authors.lastname: Seiler
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000209:etiology* / Q000628:therapy; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012086:Reoperation; D020521:Stroke / Q000209:etiology; D013557:Switzerland; D016896:Treatment Outcome