Background
Recent data support transcatheter closure of patent foramen ovale (PFO) to reduce the risk of recurrent events in patients with PFO-related stroke. Transcatheter PFO closure of PFO has become the clinical standard in adults ≤ 60 years with cryptogenic stroke and PFO. However, guidance regarding post-interventional follow-up and information on mid-and long-term device complications in clinical practice are lacking.
Objective
The purpose of this study was to determine the closure rate and 6 months incidence of device-related complications after transcatheter closure of PFO using transesophageal echocardiography (TOE).
Methods
A cohort of 220 patients (median: 51 years, 40 % women) undergoing transcatheter PFO closure was retrospectively analyzed. After a median follow-up of 6 months after PFO closure, all patients received TOE including semiquantitative color Doppler and contrast bubble test spontaneously and after provocation (modified Valsalva). Complete PFO occlusion, residual right-to-left shunt (RLS) and potential complications like device-related thrombosis and device embolism were assessed.
Results
Complete PFO occlusion was confirmed in 192 (87 %) of patients. Residual RLS was observed in 22 (10 %) of patients at follow-up TOE. In 16 out of these 22 patients shunting was observed spontaneously at rest, with an insignificantly small jet in the majority of patients (77 %). In 6/22 patients residual shunting was only present during the modified Valsalva maneuver (27 %). Device-related complications were rare (1 device associated thrombosis, 1 device suspected embolization, respectively 0,5 %).
Discussion
Our data on postinterventional TOE confirm that transcatheter PFO closure is a safe procedure with a high success rate. Overall, rates of effective PFO closure vary from 67 to 95 % based on TTE and 71 to 96 % on TOE, associated device-related complications are rare (1 - 3 %).
