title: Efficiency of transcatheter patent foramen ovale closure in children after paradoxical embolism events.
abstract: OBJECTIVE
  Patent foramen ovale (PFO) may result in a cerebrovascular event - a presumed paradoxical embolism (PE). However, the presence of this phenomenon among paediatric patients was rarely evaluated. Transcatheter PFO closure was considered to be a method of treatment in such patients.
  
  
  METHODS
  For evaluation clinical data and long-term outcome, we reviewed records of patients below 18 years of age, with history of cerebrovascular event related to PE, who underwent procedure of percutaneous PFO closure in years 1999-2014 in our department.
  
  
  RESULTS
  Among 230 patients with cerebrovascular events who had PFO closed percutaneously, seven children (aged 12-16 years, five male) were selected. Indications for closure were cryptogenic stroke in two patients and transient ischaemic attack (TIA) in five patients. Diagnosis of PFO was established by transthoracic echocardiography, with right-to-left shunt (RLS) through PFO confirmed by transoesophageal echocardiography. Contrast transcranial Doppler (c-TCD) was performed preprocedurally in four patients, revealing significant RLS. For percutaneous closure of PFO different occluders (Starflex, Amplatzer PFO devices, Cardio-O-Fix) were used. Closure was successfully completed in all patients and no procedure-related complications were observed. Postprocedural c-TCD six months after closure revealed no significant RLS. During follow-up (3 to 10 years) one patient had an episode of recurrent TIA; however, in this patient paroxysmal atrial fibrillation was found during the follow-up period.
  
  
  CONCLUSIONS
  Cerebral embolism due to PFO is uncommon in children. Transcatheter PFO closure in this group of patients is a safe and effective procedure. C-TCD is plausible technique for detection RLS and monitoring PFO closure efficacy in this group of patients.
authors.affiliation: Department of Neurology, Public Clinical Hospital No. 1, Medical University of Silesia, Zabrze, Poland. mcwaw@mp.pl.
authors.forename: Maciej
authors.initials: M
authors.lastname: Wawrzyńczyk
authors.forename: Michał
authors.initials: M
authors.lastname: Gałeczka
authors.forename: Blandyna
authors.initials: B
authors.lastname: Karwot
authors.forename: Mateusz
authors.initials: M
authors.lastname: Knop
authors.forename: Jacek
authors.initials: J
authors.lastname: Białkowski
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization; D002648:Child; D019320:Embolism, Paradoxical / Q000209:etiology*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008297:Male; D016896:Treatment Outcome
keywords: cerebrovascular event; paradoxical embolism; patent foramen ovale; transcatheter closure