title: Efficacy of percutaneous closure of patent foramen ovale: comparison among three commonly used occluders.
abstract: BACKGROUND
  Percutaneous closure of patent foramen ovale (PFO) is standard treatment for patients with paradoxical embolism but studies examining the efficacy of the various occluders are lacking.
  
  
  OBJECTIVE
  To evaluate short- and medium-term closure rates of three common occluders.
  
  
  METHODS
  One hundred and sixty-six adults (47±12 (18-81 years)) were evaluated with transthoracic bubble echocardiography before and after PFO closure. Only patients with large PFOs were included (>30 bubbles in the left heart after Valsalva).
  
  
  RESULTS
  Three occluders were used: Amplatzer (AGA Medical Corporation) (n=80, 48%), Gore Helex (n=48, 29%) and Premere TM (St Jude Medical) (n=38, 23%). One (0.6%) neurological event occurred during follow-up. At 6 months significant residual shunting after Valsalva was highest in the group that received the Helex (58.3%), and lower for Premere (39.5%) and Amplatzer (32.5%). At final follow-up residual shunting remained higher in patients with the Helex (33.3%) than in Premere (18.5%) and Amplatzer (11%). Amplatzer had a significantly lower residual shunt rate than Helex (p<0.05 at 6 months and final follow-up). The Premere had an intermediate residual shunt rate. Septal aneurysm also predicted residual shunting (RR=24.7, 95% CI: 8.2 to 74.4, p<0.0001).
  
  
  CONCLUSIONS
  Percutaneous PFO closure is an efficacious progressive treatment but closure rates also depend on the presence of aneurysm and differ between occluders.
authors.affiliation: Adult Congenital Heart Unit, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK. rajesh.thaman@wales.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Thaman
authors.forename: G
authors.initials: G
authors.lastname: Faganello
authors.forename: J R
authors.initials: JR
authors.lastname: Gimeno
authors.forename: G V
authors.initials: GV
authors.lastname: Szantho
authors.forename: M
authors.initials: M
authors.lastname: Nelson
authors.forename: S
authors.initials: S
authors.lastname: Curtis
authors.forename: R P
authors.initials: RP
authors.lastname: Martin
authors.forename: M S
authors.initials: MS
authors.lastname: Turner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D005260:Female; D054092:Foramen Ovale, Patent / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055989:Septal Occluder Device; D016896:Treatment Outcome; D055815:Young Adult