Transcatheter patent foramen ovale closure is effective in reducing migraine independently from specific interatrial septum anatomy and closure devices design.
BACKGROUND
Relationships between migraine improvement after transcatheter patent foramen ovale (PFO) closure and both specific interatrial septum anatomy and different devices design have not been investigated yet. We sought to assess effectiveness of transcatheter PFO closure in reducing or curing migraine with aura in patients with previous paradoxical embolism in relation with specific interatrial septum anatomy and different closure devices.


RESULTS
We prospectively enrolled 34 patients (22 female and 12 male, mean age 40 + or - 3.7 years) who were referred to our centre over a 12-month period for PFO transcatheter closure and migraine with aura and previous paradoxical embolism. All procedures were performed using mechanical intracardiac echocardiographic guidance. Patients were assigned to Amplatzer PFO or ASD Multifenestrated Occluder and Premere Occlusion System implantation dependently from intracardiac echocardiography anatomical findings, which included short-channel with moderate atrial septal aneurysm (ASA) in 6 patients (17.6 %), long-channel with moderate ASA in 3 patients (8.8%), short-channel with huge ASA in 5 patients (14.7%), multifenestrated ASA in 4 patients (11.7%), long-channel PFO without ASA in 10 patients (29.4%), and long-channel PFO with mild ASA in 6 patients (17.6%). Accordingly, 18 patients received an Amplatzer Occluder (9 PFO Occluder and 7 ASD Multifenestrated Occluder), and 16 received a Premere Occlusion System. After a mean follow-up of 9.0 + or - 2.8 months, all patients improved their migraine symptoms (mean Migraine Disability Assessment Score 30 + or - 1.5 at baseline versus 6.0 + or - 2.9 in the follow up, P<.03) independently from specific interatrial septum anatomy and different closure devices.


CONCLUSIONS
Although our study had several limitations, it suggests that independently from interatrial septum anatomy and device type, PFO closure in patients with migraine with aura resulted in a high rate of migraine improvement.
Cardiovascular Diagnosis and Interventions Unit, Rovigo General Hospital, Verona, Italy. jackyheart@hotmail.com
Gianluca
G
Rigatelli
Paolo
P
Cardaioli
Fabio
F
Dell'Avvocata
Massimo
M
Giordan
Gabriele
G
Braggion
Mauro
M
Chinaglia
Loris
L
Roncon
D000328:Adult; D054087:Atrial Septum / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization / Q000295:instrumentation*; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D020325:Migraine with Aura / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D011474:Prosthesis Design; D055989:Septal Occluder Device; D016896:Treatment Outcome; D014463:Ultrasonography