Setting up a multidisciplinary program for management of patent foramen ovale-mediated syndromes.
BACKGROUND
These days no codified multidisciplinary protocol has been reported to manage all the different patent foramen ovale (PFO)-mediated syndromes. We sought to propose a multidisciplinary program of diagnosis, treatment, and follow-up of all PFO-mediated syndromes based on an in-hospital multidisciplinary task force and to review the activities during the first year.


METHODS
From September 2004, we organized in our hospital, a 600-bed tertiary hospital, a management program for PFO-mediated syndromes based on a task force composed of cardiologists, neurologists, and internists. Different levels of protocols were created in order to cover diagnosis, treatment, and follow-up of PFO-mediated syndromes. We reviewed the activity of our program in the first year up to September 2005.


RESULTS
Thirty-five patients (23 female, mean age 65 +/- 24 years) were evaluated for suspected PFO-mediated syndromes: 20 for cryptogenic stroke, 2 for peripheral and coronary embolisms, 3 for platypnea-orthodeoxia, 9 for emicrania with aura, and 1 with hypoxiemia during neurosurgical intervention in the posterior cranial fossa. Diagnosis of PFO was confirmed in 25 patients. According to the multidisciplinary protocols, 15 patients failed to meet the requirements for transcatheter closure and were left in medical therapy whereas 11 patients (7 patients with PFO, 2 with multiperforated ASD, and 2 with a secundum ASD) underwent transcatheter closure. After a mean follow-up of 10.8 +/- 4.9 months, no recurrent PFO syndromes were noted in patients treated with devices.


CONCLUSIONS
The first year of our multidisciplinary program allowed a reasonable and potentially successful approach for correctly identifying patients with PFO-mediated syndromes until randomized studies are completed.
Rigatelli
Gianluca
G
Interventional Cardiology Unit, Rovigo General Hospital, Rovigo, Italy. jackyheart@hotmail.com
Braggion
Gabriele
G
Chinaglia
Maurizio
M
Cardaioli
Paolo
P
Roncon
Loris
L
Giordan
Massimo
M
Cuppini
Stefano
S
Aggio
Silvio
S
Bortolazzi
Alessandra
A
Zonzin
Pietro
P
D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D016730:Program Development; D011446:Prospective Studies; D013577:Syndrome; D016896:Treatment Outcome