Percutaneous Patent Foramen Ovale (PFO) closure in young patients with both cryptogenic brain infarction and PFO associated with Atrial Septal Aneurysm (ASA).
BACKGROUND
To assess the safety and efficacy of percutaneous patent foramen ovale (PFO) closure for the prevention of recurrent stroke in high-risk patients.


RESULTS
Between January 2002 and March 2005, 40 patients (65% female), mean (SD) age 43 (10) years were identified using the following inclusion criteria: <60 years, recent brain infarction (<3 months), combination of PFO plus atrial septal aneurysm (ASA) and exclusion of any other thromboembolic cause. Percutaneous PFO closure was performed under general anaesthesia and under the guidance of transoesophageal echocardiography (TEE). Aspirin and clopidogrel were given for three months after PFO closure, followed by aspirin alone. Neurological examination was performed every three months.


RESULTS
PFO closure was successful in all patients, using all devices: INTRASEPT in 34 cases, STARFlex in 5 cases and AMPLATZER in one case. At day one, transthoracic echocardiography (TTE) excluded malpositioning of the device or pericardial effusion. At 6 months, TTE and TEE confirmed satisfactory implantation of the device, with no spontaneous shunt. No device related thrombi was observed. Mean patient follow-up was 17+/-7 months (range 12-38) and was 100% complete. No patients suffered from recurrent stroke (neither transient ischaemic attack nor brain infarction).


CONCLUSIONS
This preliminary experience is encouraging for PFO closure with a 0% risk of stroke recurrence rate in a high-risk subset of patients (< 60 years, recent cryptogenic stroke, PFO plus ASA) and is safe using the current technology. Larger series with longer follow-up and randomised studies are still necessary in this setting before the completion of guidelines.
Juliard
Jean-Michel
JM
Department of cardiology, Hôpital Bichat, Paris, France.
Abboud
Halim
H
Aubry
Pierre
P
Brochet
Eric
E
Sauguet
Antoine
A
Depoix
Jean-Pol
JP
Philip
Yvan
Y
Messika-Zeitoun
David
D
Lung
Bernard
B
Vahanian
Alec
A
Amarenco
Pierre
P