Korean Circ J.  2011 Jul;41(7):356-362. 10.4070/kcj.2011.41.7.356.

Intermediate and Long-Term Results of Transcatheter Closure of Patent Foramen Ovale Using the Amplatzer Patent Foramen Ovale Occluder: One Case of Pulmonary Embolism Irrespective of Patent Foramen Ovale Closure

• Yoon JH
• Kim JS
• Lee DH
• Shim EJ
• Lee SY
• Min KS
• Cho DJ
• Lee HR

• KMID: 2225098
• DOI: http://doi.org/10.4070/kcj.2011.41.7.356

Abstract

BACKGROUND AND OBJECTIVES
Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke or transient ischemic attack (TIA) due to paradoxical embolism, and in the pathogenesis of migraine. This paper reports the intermediate and long-term results of transcatheter closure of PFO associated with cerebrovascular accidents (CVAs), TIAs and migraine, using the Amplatzer PFO occluder. This paper also reports a case of pulmonary embolism which developed in one patient after PFO closure.
SUBJECTS AND METHODS
From January 2003 to May 2010, 16 patients with PFO (seven males and nine females) with a history of at least one episode of cryptogenic stroke/TIA, CVA, or migraine and who underwent percutaneous transcatheter closure of PFO using the Amplatzer occluder. All the procedures were performed under general anesthesia and were assisted by transesophageal echocardiography.
RESULTS
The device was implanted without any significant complications in all the patients, and the PFOs were effectively closed. At an average follow-up period of 54 months, the 15 patients with TIA/CVA had no recurrence of any thromboembolic event. The symptoms in one patient with migraine subsided after occlusion of the PFO. In this study, pulmonary embolism occurred five months after PFO closure in one patient, but the cause of pulmonary embolism was not identified. However, it is believed that the pulmonary embolism occurred without stroke recurrence because occlusion of the PFO was performed when the patient had a stroke event.
CONCLUSION
It can be concluded that according to the intermediate and long-term follow-up results, transcatheter PFO closure is an effective and safe therapeutic modality in the prevention of thromboembolic events, especially in the patients with cryptogenic stroke/TIA, and PFO closure is helpful in the treatment of migraine. However, this study involved a small number of patients and also the follow-up period was not long enough. Hence, randomized, controlled trials are necessary to determine if this approach is preferable to medical therapy for the prevention of recurrent stroke or as primary treatment for patients with migraine headache.

Keyword

Patent foramen ovale; Stroke; Transient ischemic attack; Migraine; Pulmonary embolism

MeSH Terms

Anesthesia, General
Embolism, Paradoxical
Follow-Up Studies
Foramen Ovale, Patent
Humans
Ischemic Attack, Transient
Male
Migraine Disorders
Pulmonary Embolism
Recurrence
Septal Occluder Device
Stroke

Figure

• 

  Fig. 1 Amplatzer PFO occluder (AGA Medical Corporation) is a self expandable, double disc device made from Nitinol wire mesh. The two discs are linked together by a short connecting waist allowing free motion of each disc.

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  Fig. 2 PFO occlusion using the Amplatzer PFO occluder. A: the selective superior vena cava angiography after the implantation of Amplatzer PFO occluder (arrow). B: the simple chest radiography, lateral view 5 months after PFO closure (arrow). PFO: patent foramen ovale.

• 

  Fig. 3 Recurrence stroke was detected on an MRI scan. A: 1st acute infarction in the left middle cerebral artery-left frontotemporal lobe, insular cortex, and basal ganglia (arrow). B: 2nd acute infarction (2 months later)-left frontal lobe (arrow).

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  Fig. 4 Chest X-ray (sitting position) shows prominent right hilum and decreased pulmonary vascularity when the patient was admitted again via emergency room with dyspnea, five months after the patent foramen ovale closure.

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  Fig. 5 Patients' 2D echocardiogram revealed severe pulmonary hypertension, right ventricular dysfunction, and tricuspid regurgitation. A: the 2D echocardiogram (2 chamber view) revealed right ventricular dysfunction (right ventricle is larger than the left ventricle). B: pulmonary hypertension and tricuspid regurgitation (arrow). 2D: 2-dimensional, RV: right ventricle, LV: left ventricle.

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  Fig. 6 When the patient was admitted again via emergency room with dyspnea, five months after PFO closure, neither thromboembolism nor shunt was observed in this case treated using the Amplatzer PFO occluder (arrow). PFO: patent foramen ovale.

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  Fig. 7 Chest CT angiography shows acute pulmonary embolism (arrow).

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