title: Recurrent and Residual Shunts After Patent Foramen Ovale Closure: Results From a Long-Term Transcranial Doppler Study.
abstract: OBJECTIVE
  Assess the evolution of right-to-left shunt (RLS) after transcatheter patent foramen ovale (PFO) closure.
  
  
  BACKGROUND
  Despite the high number of interventional procedures performed worldwide, limited systematic data on the long-term abolition of RLS after percutaneous closure are available.
  
  
  METHODS
  All patients treated at our Institution between February 2001 and July 2009 were included in this single center, prospective study, and were asked to repeat late contrast transcranial Doppler (cTCD). Rate of complete closure, residual RLS (i.e., a shunt that persists after closure), and recurrent RLS (i.e., a shunt that reappears after a previous negative cTCD) was assessed.
  
  
  RESULTS
  Long-term follow-up was completed in 120 patients (56% male). RLS was still detectable 4.9 ± 2.3 years (range 1.3-10.3) after the procedure in 55 patients; 20 (17%) had residual RLS and 35 (29%) had recurrent RLS. Multivariate analysis revealed that significant predictors of residual RLS included post-procedural shunt at transesophageal echocardiography (OR 3.07, 95%CI 0.97-9.7), use of a bigger device (35 vs 25 mm, OR 3.85, 95%CI 1.22-12.2) and length of follow-up (OR 0.75, 95%CI 0.57-0.98), while only length of follow-up (OR 0.77, 95%CI 0.62-0.95) was associated with recurrent RLS. Neurological recurrences (1 stroke, 6 transient ischemic attacks) were equally distributed between the groups.
  
  
  CONCLUSIONS
  A significant number of recurrent and residual shunts may be observed by cTCD up to 5 years after PFO closure. Management of late RLSs includes periodic re-evaluation, exclusion of device-induced complications or secondary sources of RLS, and optimization of antithrombotic treatment with or without a second intervention.
authors.affiliation: Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Martino
authors.initials: M
authors.lastname: Cheli
authors.affiliation: Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.|Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland.
authors.forename: Marco
authors.initials: M
authors.lastname: Canepa
authors.affiliation: Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunelli
authors.affiliation: Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Bezante
authors.affiliation: Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Favorini
authors.affiliation: Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Rollando
authors.affiliation: Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Childhood Sciences, University of Genoa, Genoa, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Sivori
authors.affiliation: Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Childhood Sciences, University of Genoa, Genoa, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Viani
authors.affiliation: Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Childhood Sciences, University of Genoa, Genoa, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Finocchi
authors.affiliation: Cardiology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Manrico
authors.initials: M
authors.lastname: Balbi
mesh_terms: D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult