Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism: procedural and follow-up results after implantation of the Amplatzer®-occluder device.
BACKGROUND
Prevalence of patent foramen ovale (PFO) with detectable right-to-left shunt is higher in young adults with transient ischemic attack (TIA) and stroke compared to the general population. So far, published series included different occluder systems, various indications and regimens of postprocedural anticoagulation. In our experience, occluder systems may be associated with an increased prevalence of thrombus formation, which has also reported by other groups. The aim of the present study was to evaluate the follow-up results after implantation of the Amplatzer® occluder in patients with PFO using a consistent anticoagulation regimen.


RESULTS
One-hundred and fourteen patients with PFO (60 men; age: 47 ± 13 years) and ≥1 thromboembolic event were included. Other causes for embolism were excluded. PFO-closure was successful in all patients. All patients were treated with aspirin (100 mg/day) and clopidogrel (75 mg/day) for 6 months. TEE was repeated at a mean of 10.3 months. Mean clinical follow-up period was 18 ± 9 months. After a mean of 10 months, no patient had either a significant residual shunt nor a suspected thrombus formation on the occluder. During follow-up, 5 patients suffered from neurological events (1 stroke, 2 TIAs, 2 epileptic seizures), though complete closure of the PFO was documented by TEE. One patient suffered from bleeding complications (upper GI-bleeding).


CONCLUSIONS
Percutaneous closure of PFO in symptomatic patients by Amplatzer® occluder represents an effective therapy with a low incidence of peri-interventional complications and recurrent thromboembolism. Thrombus formations on the occluder system were not detected in this cohort.
Fischer
Dieter
D
Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Hannover, Germany. fischer.dieter@mh-hannover.de
Haentjes
Jonas
J
Klein
Gunnar
G
Schieffer
Bernhard
B
Drexler
Helmut
H
Meyer
Gerd P
GP
Schaefer
Arnd
A
D001241:Aspirin / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D000077144:Clopidogrel; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D002546:Ischemic Attack, Transient; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device / Q000706:statistics & numerical data*; D020521:Stroke; D011795:Surveys and Questionnaires; D013923:Thromboembolism; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin