Incidence, predictive factors, and prognostic impact of residual shunt after percutenous patent foramen ovale closure
Quentin LaissacT. LevesqueNicolas BettingerT. HemeryChristophe TronE. Guégan-MassardierH. EltchaninoffÉric Durand
1
Citation
0
Reference
10
Related Paper
Citation Trend
Keywords:
Valsalva maneuver
Medical record
Stroke
Through advancements in transcatheter technology, a patent foramen ovale (PFO) can now be closed by either a percutaneous or surgical procedure. This report presents a patient who suffered an embolic stroke secondary to a PFO. The PFO was successfully closed surgically, but 7 years later the foramen ovale was found to be widely patent. The patient underwent successful percutaneous PFO closure and the foramen ovale remains closed. This case demonstrates that percutaneous PFO closure may be viable in patients in whom surgical closure has not provided long-term closure.
Closure (psychology)
Foramen ovale (heart)
Cite
Citations (4)
Aim: Patent foramen ovale (PFO) is discussed as a source of paradoxical embolism in cryptogenic stroke. In clinical routine, PFO can be diagnosed either by echocardiography or by transcranial ultrasound after application of an ultrasonic contrast agent. It is commonly recommended to start the Valsalva maneuver (VM) 10s after injection of the contrast agent in the right antecubital vein. The observation that in patients with known PFO microbubbles occur mainly a few seconds after the release of the VM and only sparsely during the maneuver itself, induced this study, in which we compared the rate of detected PFOs after performing the recommended VM to a modified technique.
Valsalva maneuver
Paradoxical Embolism
Transcranial Doppler
Stroke
Foramen ovale (heart)
Cerebral embolism
Cite
Citations (0)
Background: Because transcatheter closure of patent foramen ovale (PFO) has become effective for preventing cryptogenic stroke (CS), it is necessary to determine high-risk PFO associated with CS. This study aimed to clarify the importance of direct right-to-left (RL) shunt through the PFO for identifying high-risk PFO. Methods: We analyzed 137 patients with and without CS who were confirmed to have PFO. The timing of RL shunt through the PFO was evaluated by cardiac cycles after right atrium (RA) opacification on saline contrast transesophageal echocardiography. Direct RL shunt was defined as microbubbles crossing the PFO before and at the same time of RA opacification. Results: Cardiac cycles of microbubbles crossing the PFO were shorter in patients with CS than in those without CS (2.0 ± 2.2 vs. 0.5 ± 1.1, P < .01). Direct RL shunt was more frequently observed in patients with CS than in those without CS (77% vs. 29%, P < .01), with a sensitivity of 79% and a specificity of 71% for the association with CS. Multivariate analysis revealed that direct RL shunt was related to atrial septal aneurysm and low-angle PFO. Regarding functional features of PFO, the detection rate of CS was 50% for large RL shunt alone, and was increased to 83% when direct RL shunt was added. Conclusion: Direct RL shunt was associated with CS and had the incremental value in detecting PFO associated with CS for large RL shunt. The timing of RL shunt can be valuable for identifying high-risk PFO.
Right-to-left shunt
Cite
Citations (0)
Objective To study the value of echocardiography in transcatheter closure treatment of patent foramen ovale (PFO). Methods The study included 7 cases of PFO treated by transcatheter closure. Before operation transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) examination were performed. The standard for the closure treatment was cryptogenic stroke and PFO accompanied with right to left shunt. During operation, TTE was used for guiding and monitoring the whole process. After operation TTE was used for follow up. In addition, 157 PFO cases diagnosed by TTE were analysed. Results The right to left shunt in 7 PFO cases were diagnosed by echocardiography (1 by TTE, 4 by TEE, 1 by TTE + contrast echocardiography and 1 by TEE + contrast echocardiography). During operation TTE could guide and monitor the procedure satisfactorily. The transcatheter closures were successful in all 7 cases. After 6-18 month follow-up, no residual shunt or complications was found by TTE. In the 157 PFO were diagnosed by TTE, there were 76 cases younger than 1 year old, 81 cases more than 1 year old. In 157 PFO cases, 88 cases had no other cardiac abnomality except PFO, 69 cases accompanied with other cardiac structure or function abnormality,while 132 cases showed left to right shunt,11 cases showed right to left shunt, 18 cases showed bidirection shunt. PFO with right to left or bidirection shunt more often be found in the cases accompanied other cardiac structure or function abnormality. Conclusion Echocardiography plays an important role in selecting cases before the operation, guiding and monitoring during the operation and following up after the operation. In the diagnosis of right to left shunt of PFO, the sensitivity of TEE with contrast is higher than that of TTE. Most PFO showes left to right shunt and not right to left as described in old definition during common TTE examination.
Right-to-left shunt
Abnormality
Cardiac catheterization
Shunting
Cite
Citations (0)
Percutaneous closure of patent foramen ovale (PFO) has been proposed as the treatment of choice for young high-risk patients who suffered cryptogenic stroke and/or peripheral paradoxical embolism. We sought to compare prospectively two different devices used for percutaneous PFO closure.Prospective data were collected on 40 high risk patients (females: 38%, mean age : 44 +/- 11 years, interatrial septal aneurysm >10 mm: 68%) who underwent percutaneous PFO closure after cryptogenic stroke (n = 38) or peripheral paradoxical embolism (n = 2). Chronologically, 20 patients were first treated by a PFO-Star (Cardia, Burnsville, MI) device. Then, 20 other patients received a Starflex occluder (NMT, Boston, MA). The primary endpoint was complete PFO closure at 6 months as assessed by transthoracic contrast echocardiography. Secondary endpoints were major peri- or post procedural complications and clinical recurrence at 1 year follow-up.Baseline clinical and anatomical characteristics were comparable for both groups. Complete PFO closure was observed in 50% (PFO-Star) and 90% (Starflex) of patients (p=0.001) respectively. Major peri-procedural complications occurred in the PFO-star group only: right-sided device thrombus (1 patient) and aorto-right atrial fistula (1 patient). At 1 year follow-up, no clinical recurrence occurred.In conclusion, despite the absence of clinical recurrence in this high-risk population with presumed paradoxical embolism, complete PFO closure at 6 months follow-up was significantly related to the type of closure device used.
Paradoxical Embolism
Closure (psychology)
Foramen ovale (heart)
Stroke
Cite
Citations (9)
Conventional percutaneous closure of patent foramen ovale (PFO) is usually performed under the guidance of fluoroscopy. Whether closure of PFO under transthoracic echocardiography (TTE) guidance only is safe and effective is unknown. The present study therefore aimed to assess the safety and efficacy of percutaneous closure of PFO under TTE guidance only.This study retrospectively enrolled a total of 52 consecutive patients (55.8% male, mean age 34.0±13.0 years, range, 10-59 years) with PFO treated at our institution from June 2015 to September 2017 by percutaneous closure under echocardiographic guidance only. The patients mean body weight was 58.7±10.8 kg. Patients underwent follow-up by TTE immediately post procedure by electrocardiogram and TTE at 1, 3, 6 and 12 months after discharge and annually thereafter, and by clinical evaluation at all time points.Of the 52 patients, 47 (90.4%) were successfully treated by percutaneous closure under TTE guidance. The mean procedure duration (from puncture to sheath removal) was 21.0±6.2 (range, 11-33) minutes. A trivial residual shunt which disappeared 24 hours later was observed in only 1 (1.9%) patient immediately post procedure. Median hospital stay was 3.0 days without severe complications such as peripheral vascular injury or cardiac perforation at discharge. At median 15.5 (11.3, 18.0) months follow-up, there were no complications such as death, stroke, transient ischemic attack (TIA) and residual shunt.In this single center study of mostly lean patients, percutaneous closure of PFO under TTE guidance as the only imaging tool appeared effective at midterm follow-up, while avoiding radiation exposure, endotracheal intubation and contrast agent use.
Closure (psychology)
Cite
Citations (7)
Background: Percutaneous closure of patent foramen ovale (PFO) has been increasingly performed for several indications; mostly due to cryptogenic stroke. In this study we aimed to evaluate the safety and efficacy of transthoracic echocardiographic (TTE) guidance during percutaneous closure of PFO in using the Amplatzer and Occlutech Figulla PFO occluder devices. Methods: Between October 2005 and March 2011, 139 patients (74 male, mean age: 40.4 ± 10.3) underwent transcatheter PFO closure. In all patients transesophageal echocardiography performed subsequently to diagnose, assess the size and evaluate for suitability of the defect for percutaneous closure. During the procedure fluoroscopy and TTE were used for guidance. Results: Among 139 patients, Amplatzer PFO occluder was used in 74 patients and in 65 of them Occlutech Figulla device was selected for occlusion. The indications for PFO closure were ischemic stroke in 98 (70.5%), recurrent transient ischemic attacks (TIA) in 40 (28.7%), peripheral embolism in 1 (0.8%) of the patients. In all patients, percutaneous intervention was performed successfully under TTE guidance. There have been no neurologic (recurrent strokes or TIAs) and cardiovascular complications during the immediate and long‐term follow‐up period (2–67 months, median 29). There was significant difference between the mean fluoroscopic time from the beginning which is 8.6 ± 3.4 min in the former versus 3.4 ± 1.9 min in the latter (P < 0.05). Conclusion: Our study confirms the efficacy and safety of TTE guidance during percutaneous closure of PFO, which shortens the procedural time and obviates the need for general anesthesia or endotracheal intubation. (Echocardiography 2011;28:1074‐1080)
Paradoxical Embolism
Stroke
Foramen ovale (heart)
Cite
Citations (16)
Foramen ovale (heart)
Cite
Citations (24)
The purpose of this study was to investigate the importance of an adequately performed Valsalva maneuver for detecting a right-to-left shunt indicating reopening of the functional closure of the foramen ovale.We prospectively analyzed 260 patients (102 women and 158 men; mean age ± SD, 41 ± 19 years; range, 13-83 years) who underwent transesophageal echocardiography and agitated saline injection. Two-dimensional echocardiography, color Doppler imaging, and microbubbles were used to detect right-to-left shunts, and the Valsalva maneuver was performed to determine whether the functional closure of the foramen ovale had reopened.Transesophageal echocardiography with color Doppler imaging identified a patent foramen ovale in 20 patients: 18 patients with a patent foramen ovale had left-to-right shunts, and 2 patients with atrial septal defects had bidirectional shunts. Both patients with atrial septal defects showed right-to-left shunt microbubbles without and with the Valsalva maneuver, whereas all 18 patients with a patent foramen ovale showed right-to-left shunt microbubbles only after the Valsalva maneuver. Foramen ovale reopening was identified by transesophageal echocardiography in an additional 40 patients with no shunt during rest on agitated saline injection and in whom the right-to-left shunt appeared only after the Valsalva maneuver. The Valsalva maneuver could cause an atrial septal swing, and its sensitivity and specificity were 100%.An adequately performed Valsalva maneuver is important for detecting a right-to-left shunt indicating reopening of the functional closure of the foramen ovale.
Valsalva maneuver
Right-to-left shunt
Foramen ovale (heart)
Shunting
Paradoxical Embolism
Cite
Citations (13)
Because transcatheter closure of patent foramen ovale (PFO) has become effective for preventing cryptogenic stroke (CS), it is necessary to determine high-risk PFO associated with CS. This study aimed to clarify the importance of direct right-to-left (RL) shunt through the PFO for identifying high-risk PFO.We analyzed 137 patients with and without CS who were confirmed to have PFO. The timing of RL shunt through the PFO was evaluated by cardiac cycles after right atrium (RA) opacification on saline contrast transesophageal echocardiography. Direct RL shunt was defined as microbubbles crossing the PFO before and at the same time of RA opacification.Cardiac cycles of microbubbles crossing the PFO were shorter in patients with CS than in those without CS (2.0 ± 2.2 vs .5 ± 1.1, p < 0.01). Direct RL shunt was more frequently observed in patients with CS than in those without CS (77% vs 29%, p < 0.01), with a sensitivity of 79% and a specificity of 71% for the association with CS. Multivariate analysis revealed that direct RL shunt was related to atrial septal aneurysm and low-angle PFO. Regarding functional features of PFO, the detection rate of CS was 50% for large RL shunt alone, and was increased to 83% when direct RL shunt was added.Direct RL shunt was associated with CS and had the incremental value in detecting PFO associated with CS for large RL shunt. The timing of RL shunt can be valuable for identifying high-risk PFO.
Right-to-left shunt
Cite
Citations (2)