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
Dataset: Eurointervention RedoPFO
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ABSTRACT: A B S T R A C T Cryptogenic stroke and migraine headache are disorders which most commonly af- fect persons younger than 55 years of age. In recent years these disorders have been found to have a strong association with inter-atrial cardiac defects, such as patent fo- ramen ovale and atrial septal defect, and support the pathophysiological mechanism of paradoxical embolism with a right-to-left shunt. With the evolution of technol- ogy, magnetic resonance imaging has more clearly defined cryptogenic stroke, and percutaneous cardiac interventional devices have offered a simplified approach to closure of inter-atrial cardiac defects. Nevertheless, the evidence-based data of which sub-populations of patients with cryptogenic stroke or migraine headache will benefit from closure of inter-atrial cardiac defects is just being defined. This review offers a clinical cardiologist's viewpoint of these developments.
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ABSTRACT: Patent foramen ovale is a congenital cardiac lesion that persists into adulthood and which is present in over 25% of the adult population. Its diagnosis, evaluation and treatment have attracted increasing interest as it has been suggested that it may be associated with various pathologic conditions, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine. However, data on these associations are contradictory. Similarly, the optimum treatment of patients with patent foramen ovale is still debated. This article contains a review of the anatomy, embryology and epidemiology of the condition, its association with other clinical disorders, and current therapeutic options.Revista Espa de Cardiologia 07/2008; 61(7):738-751. DOI:10.1157/13123995 · 3.34 Impact Factor