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 journalArticlepeer-review


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
Issue number6
Publication statusPublished - Nov 15 2013


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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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