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

Autor: Butera G; Pediatric cardiology and GUCH Unit, Policlinico San Donato IRCCS, 20097, San Donato Milanese, Italy., Sarabia JF, Saracino A, Chessa M, Piazza L, Carminati M
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2013 Nov 15; Vol. 82 (6), pp. 950-8. Date of Electronic Publication: 2013 Jul 30.
DOI: 10.1002/ccd.25097
Abstrakt: 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.
(Copyright © 2013 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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