Author + information
Interatrial septal abnormalities, specifically patent foramen ovale (PFO), atrial septal defect (ASD), and atrial septal aneurysm (ASA) has been correlated with cryptogenic stroke and migraine contributed to paradoxical embolism. Although previous studies have shown that percutaneous PFO or ASD closure reduces the risk of stroke and improves a migraine, effective closure rate depends on residual shunting which may be associated with poor neurologic events. Therefore, the aim of the study was to evaluate effective transcatheter PFO or ASD closure rate and clinical outcome.
All patients who underwent percutaneous PFO or ASD closure at Beijing Tiantan Hospital between May 2015 and September 2016 were enrolled. Right-to-left shunts (RLS) were confirmed by contrast transcranial doppler (cTCD) before transcatheter closure. At 1 and 6 months after the closure, cTCD was performed to detect any residual shunt at rest and after aValsalva maneuver. A success rate of device implantation, effective closure rate, complications and recurrent neurologic events were evaluated.
A total of 40 patients (45 ± 13 years, 50% male, 35 PFO and 5 ASD) were included in the study. Thirty-two patients had a cryptogenic stroke and 8 patients had a migraine. ASA was documented in 1 patient. Before closure, severe RLS were found in 33 (82.5%) patients. All patients underwent successful device closure without complication. Cardio-O-Fix PFO Occluder was used in PFO patients and ASD Occluder was implanted in ASD patients. At 1 month of follow-up, 3 patients (7.5%) had documented moderate residual RLS and completed closure rate was 92.5%. At 6 months, 25 patients finished follow-up. Of these, moderate residual RLS was present in 1 PFO patient (4%) with an ASA and thus completed closure rate was 96%. During 6 months of follow-up, no recurrent neurological events were observed.
Transcatheter PFO or ASD closure is effective and safe procedure in patients with cryptogenic stroke or a migraine and can decrease RLS. However, it is necessary to evaluate residual RLS in long-term follow-up.