Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia: results of a multicentric French registry.
BACKGROUND
Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO).


METHODS
This French multicentric study reports on 78 patients (mean age 67 +/- 11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n = 36) and an ascending aortic aneurysm (n = 11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n = 45), Cardioseal (n = 13), Sideris (n = 11), Das Angel Wings (n = 8) and Starflex (n = 1). Closure was successful in 76 patients (97%).


RESULTS
Oxygen saturation increased immediately after occlusion from 84.6 +/- 10.7% to 95.1 +/- 6.4% (p < 0.001) and dyspnea improved from grade 2.7 +/- 0.7 to grade 1 +/- 1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15 +/- 12 months, there were 7 late deaths related to the underlying disease.


CONCLUSIONS
Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.
Guérin
P
P
Centre hémodynamique, Hôpital Guillaume et René Laënnec, CHU Nantes, Boulevard Jacques Monod, BP 1005, 440930 Nantes, France. patrice.guerin@chu-nantes.fr
Lambert
V
V
Godart
F
F
Legendre
A
A
Petit
J
J
Bourlon
F
F
De Geeter
B
B
Petit
A
A
Monrozier
B
B
Rossignol
A M
AM
Jimenez
M
M
Crochet
D
D
Choussat
A
A
Rey
C
C
Losay
J
J
D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications; D001281:Atrial Fibrillation / Q000209:etiology; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D002423:Cause of Death; D004417:Dyspnea / Q000209:etiology* / Q000628:therapy; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000628:therapy*; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000628:therapy; D008297:Male; D010100:Oxygen / Q000097:blood; D011013:Pneumonectomy; D011187:Posture; D012042:Registries; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D013577:Syndrome
D010100:Oxygen