Advertisement

Patent Foramen Ovale Closure

  • Jennifer Franke
  • Nina Wunderlich
  • Stefan C. Bertog
  • Horst Sievert
Chapter

Abstract

A patent foramen ovale (PFO) is quite common and persists in approximately 20–30% of adults. In combination with predisposing morphologic and hemodynamic conditions, this remnant interatrial communication promotes thromboembolic events, most notably cerebrovascular events. Feasible treatment strategies include antithrombotic medication (antiplatelet therapy or anticoagulation), surgery, or transcatheter defect closure. Though to date no randomized trials exist showing that medical therapy versus placebo in any patient population with cryptogenic stroke is truly effective in preventing recurrent events, current guidelines promote medical therapy over endovascular or surgical PFO closure as a first-line therapy in patients with cryptogenic stroke and a PFO. This chapter reviews the pathophysiology of presumed paradoxical embolism through a PFO, current guidelines, the history and current status of device technology, and critical aspects to consider when facing a residual shunt after transcatheter PFO closure.

Keywords

Migraine With Aura Cryptogenic Stroke Tunnel Length Residual Shunt Atrial Septal Aneurysm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Hara H, Virmani R, Ladich E, Mackey-Bojack S, Titus J, Reisman M, Gray W, Nakamura M, Mooney M, Poulose A et al (2005) Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol 46(9):1768–1776CrossRefPubMedGoogle Scholar
  2. 2.
    De Castro S, Cartoni D, Fiorelli M, Rasura M, Anzini A, Zanette EM, Beccia M, Colonnese C, Fedele F, Fieschi C et al (2000) Morphological and functional characteristics of patent foramen ovale and their embolic implications. Stroke 31(10):2407–2413CrossRefPubMedGoogle Scholar
  3. 3.
    Overell JR, Bone I, Lees KR (2000) Interatrial septal abnormalities and stroke: a meta-analysis of case–control studies. Neurology 55(8):1172–1179CrossRefPubMedGoogle Scholar
  4. 4.
    Rigatelli G, Dell’Avvocata F, Giordan M, Braggion G, Aggio S, Chinaglia M, Roncon L, Cardaioli P, Chen JP (2009) Embolic implications of combined risk factors in patients with patent foramen ovale (the CARPE criteria): consideration for primary prevention closure? J Interv Cardiol 22(4):398–403CrossRefPubMedGoogle Scholar
  5. 5.
    Homma S, DiTullio MR, Sacco RL, Sciacca RR, Mohr JP (2004) Age as a determinant of adverse events in medically treated cryptogenic stroke patients with patent foramen ovale. Stroke 35(9):2145–2149CrossRefPubMedGoogle Scholar
  6. 6.
    Meissner I, Khandheria BK, Heit JA, Petty GW, Sheps SG, Schwartz GL, Whisnant JP, Wiebers DO, Covalt JL, Petterson TM et al (2006) Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol 47(2):440–445CrossRefPubMedGoogle Scholar
  7. 7.
    Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A (2007) Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med 357(22):2262–2268CrossRefPubMedGoogle Scholar
  8. 8.
    Del Sette M, Angeli S, Leandri M, Ferriero G, Bruzzone GL, Finocchi C, Gandolfo C (1998) Migraine with aura and right-to-left shunt on transcranial Doppler: a case–control study. Cerebrovasc Dis 8(6):327–330CrossRefPubMedGoogle Scholar
  9. 9.
    Cheng TO (2000) Transcatheter closure of patent foramen ovale: a definitive treatment for platypnea-orthodeoxia. Catheter Cardiovasc Interv 51(1):120CrossRefPubMedGoogle Scholar
  10. 10.
    Germonpre P (2005) Patent foramen ovale and diving. Cardiol Clin 23(1):97–104CrossRefPubMedGoogle Scholar
  11. 11.
    Srivastava TN, Payment MF (1997) Images in clinical medicine. Paradoxical embolism – thrombus in transit through a patent foramen ovale. N Engl J Med 337(10):681CrossRefPubMedGoogle Scholar
  12. 12.
    Raaphorst J, Wouda EJ (2005) Thrombus in transit through a patent foramen ovale: paradoxical embolism. J Neurol Neurosurg Psychiatry 76(9):1199CrossRefPubMedGoogle Scholar
  13. 13.
    Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, Coste J (2001) Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 345(24):1740–1746CrossRefPubMedGoogle Scholar
  14. 14.
    Windecker S, Wahl A, Chatterjee T, Garachemani A, Eberli FR, Seiler C, Meier B (2000) Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. Circulation 101(8):893–898CrossRefPubMedGoogle Scholar
  15. 15.
    Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP (2003) Atrial anatomy in non-cardioembolic stroke patients: effect of medical therapy. J Am Coll Cardiol 42(6):1066–1072CrossRefPubMedGoogle Scholar
  16. 16.
    Furlan A, Reisman M, Massaro J, Mauri L, Adams H, Albers G, Felberg R, Herrmann H, Kar S, Landzberg M, Raizner A, Wechsler L (2010) CLOSURE I: a prospective, multicenter, randomized controlled trial to evaluate the safety and efficacy of the STARFlex® septal closure system versus best medical therapy in patients with a stroke or transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale. Circulation 122:2215–2226CrossRefGoogle Scholar
  17. 17.
    Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R et al (2006) Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Circulation 113(10):e409–e449PubMedGoogle Scholar
  18. 18.
    Messe SR, Silverman IE, Kizer JR, Homma S, Zahn C, Gronseth G, Kasner SE (2004) Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 62(7):1042–1050CrossRefPubMedGoogle Scholar
  19. 19.
    Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P (2008) Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 Suppl):630S–669SCrossRefPubMedGoogle Scholar
  20. 20.
    Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, Lock JE (1992) Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation 86(6):1902–1908CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jennifer Franke
    • 1
  • Nina Wunderlich
    • 1
  • Stefan C. Bertog
    • 2
    • 3
  • Horst Sievert
    • 1
  1. 1.CardioVascular Center FrankfurtFrankfurtGermany
  2. 2.CardioVascular Center FrankfurtFrankfurtGermany
  3. 3.Department of invasive cardiologyMinneapolis Veterans Affairs Medical CenterMinneapolisUSA

Personalised recommendations