Interventional closure with Amplatzer PFO occluder of patent foramen ovale in patients with paradoxical cerebral embolism.
Percutaneous transcatheter closure has been proposed as an alternative to surgical closure or long-term anticoagulation in patients with presumed paradoxical embolism and patent foramen ovale (PFO). We report our mid-term results of 55 consecutive symptomatic patients (mean age: 47 years, range: 20-79) who underwent percutaneous transcatheter closure of PFO after at least one event of cerebral ischemia; 16 (29%) patients had at least one transient ischemic attack and 39 (71%) patients at least one embolic stroke. Multiple embolic events had occurred in 6 (11%) patients. Percutaneous transcatheter closure was technically successful in all 55 patients (100%). For the majority of patients, an Amplatzer PFO occluder measuring 25 mm in diameter (n=49) or an Amplatzer PFO occluder measuring 35 mm in diameter (n=6) was used. Complete occlusion by color Doppler and transesophageal contrast echocardiography investigation was achieved in 96% at follow-up 3-6 months after implantation; only 2 patients had a trivial residual shunt at follow-up. Mean fluoroscopy time was 6.7 minutes (range: 1.7-47.1), and in-hospital follow-up was uneventful except for 1 patient who developed a cardiac tamponade requiring uneventful and successful needle pericardiocentesis. At a mean follow-up of 19 months (range: 3-32) no recurrent embolic neurological events was observed. Transcatheter closure of PFO with Amplatzer PFO occluder devices is a safe and effective therapy for patients with previous paradoxical embolism and aneurysmatic or nonaneurysmatic PFO. Percutaneous closure is associated with a high success rate, low incidence of hospital complications, and freedom of cerebral ischemia events.
Chatterjee
Tushar
T
Division of Cardiology, University Hospital Rostock, Rostock, Germany. tushar.chatterjee@medezin.uni-rostock.de
Petzsch
Michael
M
Ince
Hüseyin
H
Rehders
Tim C
TC
Körber
Thomas
T
Weber
Frank
F
Schneider
Henrik
H
Auf der Maur
Christoph
C
Nienaber
Christoph A
CA
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D019320:Embolism, Paradoxical / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome