title: Echocardiographic findings in simple and complex patent foramen ovale before and after transcatheter closure.
abstract: OBJECTIVE
  Percutaneous closure of patent foramen ovale (PFO) in cryptogenic cerebrovascular events is an alternative to medical therapy. The interpretation of residual shunts after implantation of different devices for PFO with different morphologies is controversial.
  
  
  RESULTS
  Transcatheter PFO closure was performed in 123 patients with a history of ≥1 paradoxical embolism using three different devices: Amplatzer (n = 46), Figulla Occlutech (n = 41), and Atriasept Cardia (n = 36). Fifty-six patients presented with simple PFO and 67 patients had complex morphologies. All patients were studied with contrast enhanced transesophageal echocardiography (TEE) before interventional procedure and thereafter at 1 and 6 months and every 6-12 months in case of incomplete closure. Definite closure was confirmed in at least two consecutive TEE studies. Various PFO morphologies were identified by TEE before device implantation. The device size to PFO diameter ratio was significantly increased in patients with complex PFO compared with those patients with a simple PFO morphology (P < 0.05). The difference between the closure rate of S-PFO and C-PFO concerning each device type was significant (Amplatzer P = 0.0027, Figulla P = 0.0043, and Atriasept P < 0.01). The mean follow-up period was 3.4 years (median 2.7 years) with a cerebrovascular re-event rate of 2.4% per year. In three patients, thrombi were detected in the 6-month TEE controls and resolved after medical therapy. In three other patients, the implantation of an adjunctive device was necessary for residual shunt.
  
  
  CONCLUSIONS
  In our series of patients, the closure rate was dependent on PFO morphology more than occluder size and type. An adjunctive device was implanted in selected cases.
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy vitar@tiscali.it cardiodiagnostica@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitarelli
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Mangieri
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Capotosto
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Tanzilli
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: D'Angeli
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Toni
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Azzano
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Serafino
authors.initials: S
authors.lastname: Ricci
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Placanica
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Ennio
authors.initials: E
authors.lastname: Rinaldi
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Khaled
authors.initials: K
authors.lastname: Mukred
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Placanica
authors.affiliation: Sapienza University, Via Lima 35, Rome 00198, Italy.
authors.forename: Rasul
authors.initials: R
authors.lastname: Ashurov
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D003287:Contrast Media; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging* / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media
keywords: Atrial device; Intracardiac shunt; Patent foramen ovale; Percutaneous transcatheter closure; Transesophageal echocardiography