title: Transcatheter patent foramen ovale closure in spite of interatrial septum hypertrophy or lipomatosis: a case series.
abstract: OBJECTIVE
  Hypertrophy and lipomatosis of the interatrial septum have been thought to be contraindications for transcatheter patent foramen ovale (PFO) and atrial septal defect closure because of the limits of current devices and the risk of suboptimal results. No reports have been produced yet about PFO closure in patients with such conditions. We retrospectively assessed the safety and effectiveness of PFO closure in patients with hypertrophy or lipomatosis of fossa ovalis rims.
  
  
  METHODS
  We searched our database of 140 consecutive patients (mean age 43 +/- 15. 5 years, 98 female patients) who underwent transcatheter PFO closure for cases of hypertrophy or lipomatosis of the interatrial septum. All patients were screened with transesophageal echocardiography before the operation. All patients underwent intracardiac echocardiography study and attempted closure.
  
  
  RESULTS
  Ten patients (7.1%) underwent an attempt at transcatheter closure in the presence of hypertrophy of the rims (eight patients) or lipomatosis (two patients). All patients were aged more than 50 years and has multiple recurrent stroke events (nine patients) or need for a posterior cerebral surgical procedure (one patient) making closure mandatory. After intracardiac echocardiography study and measurements, two 25 mm Amplatzer and eight 25 mm Premere Occlusion System devices have been implanted successfully. On mean follow-up of 36.6 +/- 14.8 months, two patients had a small residual shunt: no recurrence of stroke or aortic erosion or device thrombosis was observed during this period.
  
  
  CONCLUSIONS
  Transcatheter PFO closure in the presence of hypertrophy or lipomatosis of fossa ovalis rims is not contraindicated per se: careful evaluation of rim thickness with intracardiac echocardiography and selection of soft and asymmetrically opening devices may allow for a safe and effective PFO closure, at least in patients with no severe atrial septal aneurysm.
authors.affiliation: Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. jackyheart@libero.it
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rigatelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Dell'Avvocata
authors.forename: Massimo
authors.initials: M
authors.lastname: Giordan
authors.forename: Federico
authors.initials: F
authors.lastname: Ronco
authors.forename: Gabriele
authors.initials: G
authors.lastname: Braggion
authors.forename: Nella
authors.initials: N
authors.lastname: Schenal
authors.forename: Silvio
authors.initials: S
authors.lastname: Aggio
authors.forename: Paolo
authors.initials: P
authors.lastname: Cardaioli
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006346:Heart Septum / Q000473:pathology; D006801:Humans; D006984:Hypertrophy; D008068:Lipomatosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies