Minimal access closure of patent foramen ovale: is it also recommended for patients with paradoxical emboli?
ABSTRACT To investigate the outcome of the port-access approach for patent foramen ovale (PFO) closure and to identify the long-term risk of recurrent thromboembolic events in the paradoxical embolus subgroup after closure.
Between 1997 and 2001, 31 patients underwent PFO closure using the port-access approach. Twelve of the 31 patients underwent PFO closure secondary to at least one paradoxical embolic event leading to either transient ischemic attack or cerebral infarction. All patients were followed longitudinally with office visits and telephone interviews.
The mean age was 47 years (range 18 to 85 years). All procedures were completed successfully without conversion to median sternotomy. The mean duration of aortic occlusion and cardiopulmonary bypass for all patients (n = 31) was 32 minutes (range 17 to 55 minutes) and 72 minutes (range 40 to 124 minutes), respectively. Postoperative complications included pneumonia/pulmonary embolus (n = 1), transient atrial fibrillation (n = 3, 9.7%), and exploration for bleeding (n = 3, 9.7%). No deaths were recorded. All patients were assessed using transesophageal echocardiography, and the closure of the PFO was documented. The average length of hospital stay was 3.8 days (range 2 to 10 days) for patients with paradoxical emboli. The mean follow-up period for the paradoxical embolus subgroup was 23 months (range 4 to 45 months). One patient was lost to follow-up. Neither transient ischemic attack nor cerebral infarction recurred during follow-up.
The port-access approach to PFO closure is a safe and effective procedure, with acceptable initial experience outcome and excellent low-risk rate of recurrent thromboembolic events.
- SourceAvailable from: Ronak Rajani[Show abstract] [Hide abstract]
ABSTRACT: The success rate in eliminating a right-left-shunting following percutaneous patent foramen ovale closure is estimated to be > 90%. However up to 10% of patients may have residual shunting following initial closure. Little is known as to the optimum treatment strategy for these patients. We report four cases in which to redo patent foramen ovale closure was possible with a second device. At our institution during 2008-2009, 101 patients underwent PFO closure: 81 patients (80%) underwent PFO closure for cerebrovascular events, 12 patients (12%) for migraine with aura, eight patients for systemic embolisation (8%), three patients (3%) for decompression illness and one patient underwent PFO closure for platypnea-orthodexia syndrome. Irrespective of the initial device, redo closure was technically feasible in all cases. All patients had at least a moderate residual shunt evident on echocardiographic evaluation at > 6-month follow-up. The patients in the current study were offered a redo procedure based on the presence of persistent disabling symptoms, as well as increased risk of neurological events, despite adequate antiplatelet therapy and anticoagulation. A second percutaneous interatrial septal occluder is feasible in those patients with significant residual shunting following initial closure.EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 01/2011; 6(6):735-9. · 3.17 Impact Factor
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ABSTRACT: Embolism of cardiac origin accounts for about 20% of ischemic strokes. Nonvalvular atrial fibrillation is the most frequent cause of cardioembolic stroke. Approximately 1% of population is affected by atrial fibrillation, and its prevalence is growing with ageing in the modern world. Strokes due to cardioembolism are in general severe and prone to early recurrence and have a higher long-term risk of recurrence and mortality. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke. Anticoagulation therapy's associated risk of hemorrhage and monitoring requirements have encouraged the investigation of alternative therapies for individuals with atrial fibrillation. New anticoagulants being tested for prevention of stroke are low-molecular-weight heparins (LMWH), unfractionated heparin, factor Xa inhibitors, or direct thrombin inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit stable pharmacokinetics obviating the need for coagulation monitoring or dose titration, and they lack clinically significant food or drug interaction. Moreover, they offer another potential that includes fixed dosing, oral administration, and rapid onset of action. There are several concerns regarding potential harm, including an increased risk for hepatotoxicity, clinically significant bleeding, and acute coronary events. Therefore, additional trials and postmarketing surveillance will be needed.Stroke research and treatment. 01/2011; 2011:607852.
Dataset: Eurointervention RedoPFO