title: Transcatheter treatment of atrial septal aneurysm associated with patent foramen ovale for prevention of recurrent paradoxical embolism in high-risk patients.
abstract: OBJECTIVE
  This study sought to investigate the safety and efficacy of transcatheter treatment of atrial septal aneurysm (ASA) associated with patent foramen ovale (PFO).
  
  
  BACKGROUND
  Patients with both ASA and PFO are at high risk for recurrent paradoxical embolism.
  
  
  METHODS
  The procedural, echocardiographic, and clinical outcomes of 141 patients with ASA + PFO and > or =1 paradoxical embolic event undergoing transcatheter treatment were compared with 220 patients with PFO alone.
  
  
  RESULTS
  Device success (ASA + PFO, 99.3%; PFO alone, 99.5%; p = 0.75) and procedural complications (ASA + PFO, 0.7%; PFO alone, 3.2%; p = 0.12) were similar in both groups. Maximal atrial septal excursion in patients with ASA + PFO decreased from 16 +/- 4 mm before to 4 +/- 3 mm after the intervention (p < 0.0001). At 6 months follow-up, right-to-left shunt was abolished in 120 (86%) patients with ASA + PFO, compared to 187 (85%) patients with PFO alone (p = 0.80). Freedom from recurrent transient ischemic attack, stroke, and peripheral embolism at 4 years was 95% (ASA + PFO) and 94% (PFO alone, p = 0.70), respectively. A residual right-to-left shunt after the intervention was the only predictor for recurrence (hazard ratio [HR] 6.9; 95% confidence interval [CI] 1.3 to 36.9, p < 0.03) in patients with ASA + PFO.
  
  
  CONCLUSIONS
  Transcatheter treatment of ASA + PFO is safe and effective in patients with paradoxical embolism. The procedure effectively abolishes right-to-left shunt and decreases atrial septal mobility. Long-term prevention of recurrent events appears favorable when compared to patients with PFO alone.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, CH-3010 Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wahl
authors.forename: Ulrike
authors.initials: U
authors.lastname: Krumsdorf
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.forename: Stephan
authors.initials: S
authors.lastname: Ostermayer
authors.forename: Kai
authors.initials: K
authors.lastname: Billinger
authors.forename: Markus
authors.initials: M
authors.lastname: Schwerzmann
authors.forename: Ulf
authors.initials: U
authors.lastname: Becker
authors.forename: Christian
authors.initials: C
authors.lastname: Seiler
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016896:Treatment Outcome; D014463:Ultrasonography