Optimal Device for Children and Closure Indications in Pediatric Population



Transcatheter patent foramen ovale closure has evolved into one of the most commonly performed structural interventions worldwide. Although the prevalence of patent foramen ovale may even be greater in children than adults, closure is rarely performed in this group despite susceptibility to similar defect-related morbidity. Despite an association with arterial ischemic stroke in approximately 5 % of cases and an overall stroke recurrence rate of 20 %, proof that device closure is superior to medical therapy will be significantly more challenging to prove than it has been in adult patients. Therefore as with many circumstances in interventional pediatric cardiology, treatment of patent foramen ovale in children lacks supportive data and practice varies considerably. This chapter will outline some of the indications for closure in a pediatric population, methods to circumvent some of the diagnostic challenges and a technical approach to closure in this age group.


Device Stroke Migraine Children Transcatheter Diving Atrial septum 


  1. 1.
    Pesonen E, Haavisto H, Ammälä P, Teramo K. Intrauterine hydrops caused by premature closure of the foramen ovale. Arch Dis Child. 1983;58:1015–6.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Wang NK, Shen CT, Lin MS. Results of echocardiographic screening in 10,000 newborns. Acta Paediatr Taiwan. 2007;48:7–9.PubMedGoogle Scholar
  3. 3.
    Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984;59:17–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Homma S, Sacco RL. Patent foramen ovale and stroke. Circulation. 2005;112:1063–72.PubMedCrossRefGoogle Scholar
  5. 5.
    Giannopoulos A, Gavras C, Sarioglou S, Agathagelou F, Kassapoglou I, Athanassiadou F. Atrial septal aneurysms in childhood: prevalence, classification, and concurrent abnormalities. Cardiol Young. 2013;7:1–6.Google Scholar
  6. 6.
    Fullerton HJ, Wu YW, Zhao S, Johnston SC. Risk of stroke in children: ethnic and gender disparities. Neurology. 2003;61:189–94.PubMedCrossRefGoogle Scholar
  7. 7.
    Chung B, Wong V. Pediatric stroke among Hong Kong Chinese subjects. Pediatrics. 2004;114:206–12.CrossRefGoogle Scholar
  8. 8.
    De Veber GA, MacGregor D, Curtis R, Mayank S. Neurologic out- come in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol. 2000;15:316–24.CrossRefGoogle Scholar
  9. 9.
    Zahuranec DB, Brown DL, Lisabeth LD, Morgenstern LB. Is it time for a large, collaborative study of pediatric stroke? Stroke. 2005;36:1825–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Strater R, Becker S, von Eckardstein A, et al. Prospective assessment of risk factors for recurrent stroke during childhood—a 5- year follow-up study. Lancet. 2002;360:1540–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Brankovic-Sreckovic V, Milic-Rasic V, Jovic N, et al. The recurrence risk of ischemic stroke in childhood. Med Princ Pract. 2004;13:153–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Darteyre S, Chabrier S, Presles E, et al. Lack of progressive arteriopathy and stroke recurrence among children with cryptogenic stroke. Neurology. 2012;79:2342–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Benedik MP, Zaletel M, Meglic NP, Podnar T. A right-to-left shunt in children with arterial ischaemic stroke. Arch Dis Child. 2011;96:461–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Bogousslavsky J, Garazi S, Jeanrenaud X, Aebischer N, Van Melle G. Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group. Neurology. 1996;46:1301–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Barnes C, Deveber G. Prothrombotic abnormalities in childhood ischaemic stroke. Thromb Res. 2006;118:67–74.PubMedCrossRefGoogle Scholar
  16. 16.
    Kenny D, Turner M, Martin R. When to close a patent foramen ovale. Arch Dis Child. 2008;93:255–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Butera G, Lucente M, Rosti L, et al. A comparison between the early and mid-term results of surgical as opposed to percutaneous closure of defects in the oval fossa in children aged less than 6 years. Cardiol Young. 2007;17:35–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Dowling MM, Lee N, Quinn CT, et al. Prevalence of intracardiac shunting in children with sickle cell disease and stroke. J Pediatr. 2010;156:645–50.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Carano N, Agnetti A, Hagler DJ, Tchana B, Squarcia U, Bernasconi S. Acute myocardial infarction in a child: possible pathogenic role of patent foramen ovale associated with heritable thrombophilia. Pediatrics. 2004;114:e255–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Mavromichalis I, Anagnostopoulos D, Metaxas N, et al. Prevalence of migraine in schoolchildren and some clinical comparisons between migraine with and without aura. Headache. 1999;39:728–36.PubMedCrossRefGoogle Scholar
  21. 21.
    McCandless RT, Arrington CB, Nielsen DC, Bale Jr JF, Minich LL. Patent foramen ovale in children with migraine headaches. J Pediatr. 2011;159:243–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Dowson A, Mullen MJ, Peatfield R, et al. Migraine Intervention With STARFlex Technology (MIST) trial: a prospective, multicenter, double-blind, sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache. Circulation. 2008;117:1397–404.PubMedCrossRefGoogle Scholar
  23. 23.
    Lemka M, Pienczk-Reclawowicz K, Pilarska E, Szmuda M. Cessation of sporadic hemiplegic migraine attacks after patent foramen ovale closure. Dev Med Child Neurol. 2009;51:923–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Wilmshurst PT, Byrne JC, Webb-Peploe MM. Relation between interatrial shunts and decompression sickness in divers. Lancet. 1989;2:1302–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Wilmshurst P, Bryson P. Relationship between the clinical features of decompression illness and its causes. Clin Sci. 2000;99:65–75.PubMedCrossRefGoogle Scholar
  26. 26.
    Knauth M, Ries S, Pohimann S, et al. Cohort study of multiple brain lesions in sport divers: role of patent foramen ovale. BMJ. 1997;314:701–5.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Kenny D, Turner M, Martin R. PFO closure in children. Catheter Cardiovasc Interv. 2008;71:715.PubMedCrossRefGoogle Scholar
  28. 28.
    Dalvi B, Pinto R, Gupta A. Device closure of large atrial septal defects requiring devices > or =20 mm in small children weighing < 20 kg. Catheter Cardiovasc Interv. 2008;71:679–86.PubMedCrossRefGoogle Scholar
  29. 29.
    Hornung M, Bertog SC, Franke J, et al. Long-term results of a randomized trial comparing three different devices for percutaneous closure of a patent foramen ovale. Eur Heart J. 2013;34:3362–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Thaman R, Faganello G, Gimeno JR, et al. Efficacy of percutaneous closure of patent foramen ovale: comparison among three commonly used occluders. Heart. 2011;97:394–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Amin Z, Hijazi ZM, Bass JL, Cheatham JP, Hellenbrand W, Kleinman CS. PFO closure complications from the AGA registry. Catheter Cardiovasc Interv. 2008;72:74–9.PubMedGoogle Scholar
  32. 32.
    Benedik MP, Zaletel M, Meglic NP, Podnar T. Patent foramen ovale and unexplained ischemic cerebrovascular events in children. Catheter Cardiovasc Interv. 2007;70:999–1007.PubMedCrossRefGoogle Scholar
  33. 33.
    Bartz PJ, Cetta F, Cabalka AK, et al. Paradoxical emboli in children and young adults: role of atrial septal defect and patent foramen ovale device closure. Mayo Clin Proc. 2006;81:615–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Agnetti A, Carano N, Sani E, et al. Cryptogenic stroke in children: possible role of patent foramen ovale. Neuropediatrics. 2006;​37:53–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Thomson JD, Hildick-Smith D, Clift P, et al. Patent foramen ovale closure with the Gore Septal Occluder (GSO); initial UK experience. Catheter Cardiovasc Interv. 2014;83:467–73.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Pediatrics and MedicineRush University Medical CenterChicagoUSA

Personalised recommendations