Residual shunting after percutaneous PFO closure: How to manage and how to close

Gianfranco Butera, Javier Fernandez Sarabia, Antonio Saracino, Massimo Chessa, Luciane Piazza, Mario Carminati

Research output: Contribution to journalArticle

Abstract

Introduction Initial transcatheter Percutaneous patent foramen ovale (PFO) closure attempt may be incomplete and result in persistent residual shunting. The optimal treatment strategy for these patients remains unknown. Patients and methods Twenty-seven patients were diagnosed to have a moderate-large residual shunt at least 12 months after initial PFO closure associated or not to a recurrent ischemic event and underwent a second procedure. Residual shunt characteristics were classified in two types: Type I: tunnel-like or between the disk defect (11 patients); Type II: accessory defect next to a device rim or accessory defect (16 patients). Results Fourteen subjects had a recurrent transient ischemic attack/stroke (52%). Median time between the first and the second PFO closure procedure was 17 months (range 12-60 months). Deployment of a second device was successful in 92% (25/27) patients. A Type I defect was closed by using a coil or Amplatzer Vascular Plugs. In two patients a surgical option was chosen as a first option. A Type II defect was closed by using a double disc device. At a median follow-up of 36 months (range 12-60 months), two subjects showed significant residual shunting between the two disks of the device (Type I) at 12 months follow-up and were sent to surgery. Conclusions Significant residual shunts can be successfully closed by using a second device. Care is required to select an optimal device depending on anatomy and original device. In some subjects, lack of endothelial covering account for the persistence of a significant residual shunting.

Original languageEnglish
Pages (from-to)950-958
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume82
Issue number6
DOIs
Publication statusPublished - Nov 15 2013

Fingerprint

Patent Foramen Ovale
Equipment and Supplies
Transient Ischemic Attack
Blood Vessels
Anatomy
Stroke

Keywords

  • cardiac catheterization
  • cryptogenic stroke
  • patent foramen ovale
  • transcatheter closure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Residual shunting after percutaneous PFO closure : How to manage and how to close. / Butera, Gianfranco; Sarabia, Javier Fernandez; Saracino, Antonio; Chessa, Massimo; Piazza, Luciane; Carminati, Mario.

In: Catheterization and Cardiovascular Interventions, Vol. 82, No. 6, 15.11.2013, p. 950-958.

Research output: Contribution to journalArticle

@article{786a1a17a6d04f8e8dbda02fb8c0ab0f,
title = "Residual shunting after percutaneous PFO closure: How to manage and how to close",
abstract = "Introduction Initial transcatheter Percutaneous patent foramen ovale (PFO) closure attempt may be incomplete and result in persistent residual shunting. The optimal treatment strategy for these patients remains unknown. Patients and methods Twenty-seven patients were diagnosed to have a moderate-large residual shunt at least 12 months after initial PFO closure associated or not to a recurrent ischemic event and underwent a second procedure. Residual shunt characteristics were classified in two types: Type I: tunnel-like or between the disk defect (11 patients); Type II: accessory defect next to a device rim or accessory defect (16 patients). Results Fourteen subjects had a recurrent transient ischemic attack/stroke (52{\%}). Median time between the first and the second PFO closure procedure was 17 months (range 12-60 months). Deployment of a second device was successful in 92{\%} (25/27) patients. A Type I defect was closed by using a coil or Amplatzer Vascular Plugs. In two patients a surgical option was chosen as a first option. A Type II defect was closed by using a double disc device. At a median follow-up of 36 months (range 12-60 months), two subjects showed significant residual shunting between the two disks of the device (Type I) at 12 months follow-up and were sent to surgery. Conclusions Significant residual shunts can be successfully closed by using a second device. Care is required to select an optimal device depending on anatomy and original device. In some subjects, lack of endothelial covering account for the persistence of a significant residual shunting.",
keywords = "cardiac catheterization, cryptogenic stroke, patent foramen ovale, transcatheter closure",
author = "Gianfranco Butera and Sarabia, {Javier Fernandez} and Antonio Saracino and Massimo Chessa and Luciane Piazza and Mario Carminati",
year = "2013",
month = "11",
day = "15",
doi = "10.1002/ccd.25097",
language = "English",
volume = "82",
pages = "950--958",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - Residual shunting after percutaneous PFO closure

T2 - How to manage and how to close

AU - Butera, Gianfranco

AU - Sarabia, Javier Fernandez

AU - Saracino, Antonio

AU - Chessa, Massimo

AU - Piazza, Luciane

AU - Carminati, Mario

PY - 2013/11/15

Y1 - 2013/11/15

N2 - Introduction Initial transcatheter Percutaneous patent foramen ovale (PFO) closure attempt may be incomplete and result in persistent residual shunting. The optimal treatment strategy for these patients remains unknown. Patients and methods Twenty-seven patients were diagnosed to have a moderate-large residual shunt at least 12 months after initial PFO closure associated or not to a recurrent ischemic event and underwent a second procedure. Residual shunt characteristics were classified in two types: Type I: tunnel-like or between the disk defect (11 patients); Type II: accessory defect next to a device rim or accessory defect (16 patients). Results Fourteen subjects had a recurrent transient ischemic attack/stroke (52%). Median time between the first and the second PFO closure procedure was 17 months (range 12-60 months). Deployment of a second device was successful in 92% (25/27) patients. A Type I defect was closed by using a coil or Amplatzer Vascular Plugs. In two patients a surgical option was chosen as a first option. A Type II defect was closed by using a double disc device. At a median follow-up of 36 months (range 12-60 months), two subjects showed significant residual shunting between the two disks of the device (Type I) at 12 months follow-up and were sent to surgery. Conclusions Significant residual shunts can be successfully closed by using a second device. Care is required to select an optimal device depending on anatomy and original device. In some subjects, lack of endothelial covering account for the persistence of a significant residual shunting.

AB - Introduction Initial transcatheter Percutaneous patent foramen ovale (PFO) closure attempt may be incomplete and result in persistent residual shunting. The optimal treatment strategy for these patients remains unknown. Patients and methods Twenty-seven patients were diagnosed to have a moderate-large residual shunt at least 12 months after initial PFO closure associated or not to a recurrent ischemic event and underwent a second procedure. Residual shunt characteristics were classified in two types: Type I: tunnel-like or between the disk defect (11 patients); Type II: accessory defect next to a device rim or accessory defect (16 patients). Results Fourteen subjects had a recurrent transient ischemic attack/stroke (52%). Median time between the first and the second PFO closure procedure was 17 months (range 12-60 months). Deployment of a second device was successful in 92% (25/27) patients. A Type I defect was closed by using a coil or Amplatzer Vascular Plugs. In two patients a surgical option was chosen as a first option. A Type II defect was closed by using a double disc device. At a median follow-up of 36 months (range 12-60 months), two subjects showed significant residual shunting between the two disks of the device (Type I) at 12 months follow-up and were sent to surgery. Conclusions Significant residual shunts can be successfully closed by using a second device. Care is required to select an optimal device depending on anatomy and original device. In some subjects, lack of endothelial covering account for the persistence of a significant residual shunting.

KW - cardiac catheterization

KW - cryptogenic stroke

KW - patent foramen ovale

KW - transcatheter closure

UR - http://www.scopus.com/inward/record.url?scp=84887322143&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887322143&partnerID=8YFLogxK

U2 - 10.1002/ccd.25097

DO - 10.1002/ccd.25097

M3 - Article

C2 - 23804551

AN - SCOPUS:84887322143

VL - 82

SP - 950

EP - 958

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 6

ER -