title: Percutaneous PFO closure with Amplatzer PFO occluder: predictors of residual shunts at 6 months follow-up.
abstract: OBJECTIVE
  The objective of this study was to assess predictors of residual shunts after percutaneous patent foramen ovale (PFO) closure with Amplatzer PFO occluder (AGA Medical Corporation, Golden Valley, MN, USA).
  
  
  METHODS
  All percutaneous PFO closures, using Amplatzer PFO occluder performed at a tertiary center between May 2002 and August 2006, were reviewed. Follow-up, including saline contrast transesophageal echocardiography, was performed in all patients 6 months after the intervention.
  
  
  METHODS
  A total of 135 procedures were performed. Mean age of the patients was 51 years. The indication for PFO closure was an ischemic cerebrovascular event in 92%, paradoxical systemic embolism in 4%, and a diving accident in 4%. Recurrent events prior to PFO closure were noted in 34%. A concomitant atrial septal aneurysm was present in 61%.
  
  
  RESULTS
  At 6 months follow-up, a residual shunt was detected in 26 patients (19%). Residual shunts were more common in patients with an atrial septal aneurysm (27 vs. 8%, P= .01) and in patients treated with a 35-mm compared with a 25-mm device (39 vs. 15%, P= .01). A concomitant atrial septal aneurysm remained independently associated with residual shunts when controlled for body mass index, gender, age, atrial dimensions, and presence of a Chiari network (odds ratio 4.1, 95% confidence intervals 1.1-15.0).
  
  
  CONCLUSIONS
  The presence of atrial septal aneurysms in patients undergoing percutaneous PFO closure with an Amplatzer PFO occluder significantly increases the rate of residual shunts at 6 months follow-up, even if 35-mm devices are used.
authors: Department of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada. mgreutmann@bluewin.ch
authors: Matthias
authors: M
authors: Greutmann
authors: Mehtap
authors: M
authors: Greutmann-Yantiri
authors: Oliver
authors: O
authors: Kretschmar
authors: Oliver
authors: O
authors: Senn
authors: Marco
authors: M
authors: Roffi
authors: Rolf
authors: R
authors: Jenni
authors: Thomas F
authors: TF
authors: Luescher
authors: Franz R
authors: FR
authors: Eberli
mesh_terms: D000328:Adult; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging* / Q000601:surgery*; D006322:Heart Aneurysm / Q000000981:diagnostic imaging; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome