Feasibility of patent foramen ovale closure with no-device left behind
| Autor: | Paul T.L. Chiam, Nicholas Kipshidze, Carlos E. Ruiz, Irakli Gogorishvili |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Cardiac Catheterization
medicine.medical_specialty Percutaneous Adolescent medicine.medical_treatment Migraine with Aura Septum secundum Femoral vein Foramen Ovale Patent Surgical Staplers Internal medicine medicine Valsalva maneuver Humans Radiology Nuclear Medicine and imaging Cardiac Surgical Procedures business.industry Suture Techniques Equipment Design General Medicine medicine.disease Thrombosis Surgery Stroke Treatment Outcome Fluoroscopy Chronic Disease Patent foramen ovale Cardiology Female Septum primum Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal Shunt (electrical) |
| Zdroj: | Catheterization and Cardiovascular Interventions. 71:921-926 |
| ISSN: | 1522-726X 1522-1946 |
| DOI: | 10.1002/ccd.21550 |
| Popis: | Objectives: This study evaluated the feasibility of percutaneous patent foramen ovale (PFO) closure using a transcatheter suture (Superstitch), leaving no device behind. Background: PFO has been implicated in cryptogenic strokes and migraine with auras. Percutaneous PFO closure, being less invasive than surgical closure, is increasingly performed. There are, however, early and long-term risks including device embolization, fracture, thrombosis, or infection, erosions into the free atrial wall and aorta, arrhythmias, and death. Furthermore, device implantation may complicate future percutaneous access to the left atrium. Partially reabsorbable devices and tissue welding to close PFO have recently been introduced. The first-in-man transcatheter suture closure of a PFO in an 18-year-old female with chronic migraine with aura and a well documented stroke is described. Methods: The right femoral vein was cannulated under mild sedation and local anesthesia. Using intracardiac echocardiography imaging, bubble study demonstrated a right-to-left shunt through the PFO at rest. A Superstitch device was advanced across the PFO and sutures were delivered through the septum primum and secundum. The sutures were exteriorized and a knot was advanced to the right atrial septum and cut. Results: Bubble study confirmed successful PFO suture closure. Transesophageal and transthoracic echocardiograms with bubble studies at 1 and 2 months, respectively showed complete closure with no right-to-left shunt even during Valsalva maneuver. At 6 months, the patient remained free ofsymptoms or migraine episodes. Conclusion: Percutaneous transcatheter suture closure of a PFO can be successfully achieved with no residual shunt and leaving nodevice behind. Technological refinements are required for wider scale use. © 2008 Wiley-Liss, Inc. |
| Databáze: | OpenAIRE |
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