title: Impact of percutaneous device implantation for closure of patent foramen ovale on valve insufficiencies.
abstract: BACKGROUND
  In patients with percutaneous device implantation for closure of patent foramen ovale (PFO), a 10% incidence of new or worsened aortic regurgitation within 12 months has been reported with echocardiography. Cardiac magnetic resonance imaging is a powerful noninvasive tool to quantify volume and fraction of valve insufficiencies. We studied the acute and long-term impact of percutaneous device implantation for PFO closure on valve insufficiencies in cardiac magnetic resonance imaging.
  
  
  RESULTS
  Sequential cardiac magnetic resonance imaging studies were performed in 102 patients with cryptogenic ischemic events. Cardiac magnetic resonance imaging was performed before PFO closure, the day after device implantation, and at 12 months of follow-up. There was no difference in volumetric and hemodynamic parameters before PFO closure compared with 12 months of follow-up. With a cutoff for relevant regurgitation fraction of 5%, there were no statistically significant differences in regurgitation fraction of the semilunar and atrioventricular valves. The median fraction of aortic valve insufficiency was 3.9% (interquartile range [IQR] 2.0% to 5.1%) before PFO closure, 5.4% (IQR 4.1% to 5.9%) after device implantation, and 4.3% (IQR 3.3% to 6.0%) at 12 months of follow-up. The size and type of the occluder had no impact on aortic valve insufficiency. Median regurgitation fraction for the pulmonary valve was 3.6% (IQR 2.4% to 6.7%) before intervention, 7.3% (IQR 5.1% to 8.2%) after occluder implantation and 5.8% (IQR 4.8% to 7.4%) at 12 months of follow-up. Values for the mitral valve were 3.1% (IQR 1.4% to 6.0%), 5.5% (IQR 3.5% to 7.3%), and 3.8% (IQR 1.5% to 7.9%) and for the tricuspid valve were 5.4% (IQR 0.1% to 8.8%), 5.8% (IQR 1.4% to 9.2%), and 6.0% (IQR 1.1% to 8.4%), respectively.
  
  
  CONCLUSIONS
  Percutaneous PFO closure with device implantation has no impact on valve insufficiencies as determined by cardiac magnetic resonance imaging.
authors.affiliation: Department of Internal Medicine II-Cardiology, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany. jochen.woehrle@uniklinik-ulm.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Wöhrle
authors.forename: Matthias
authors.initials: M
authors.lastname: Kochs
authors.forename: Jochen
authors.initials: J
authors.lastname: Spiess
authors.forename: Thorsten
authors.initials: T
authors.lastname: Nusser
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Hombach
authors.forename: Nico
authors.initials: N
authors.lastname: Merkle
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000473:pathology; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects / Q000706:statistics & numerical data; D011665:Pulmonary Valve Insufficiency / Q000453:epidemiology / Q000473:pathology; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology / Q000473:pathology