Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-20T17:42:31.588Z Has data issue: false hasContentIssue false
  • English
  • Français

Patent oval foramen transcatheter closure: results of a strategy based on tailoring the device to the specific patient’s anatomy

Published online by Cambridge University Press:  11 March 2010

Gianluca Rigatelli ,
Fabio Dell’Avvocata ,
Federico Ronco ,
Massimo Giordan  and
Paolo Cardaioli
Gianluca Rigatelli*
Affiliation:
Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
Fabio Dell’Avvocata
Affiliation:
Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
Federico Ronco
Affiliation:
Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
Massimo Giordan
Affiliation:
Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
Paolo Cardaioli
Affiliation:
Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
*
Correspondence to: G. Rigatelli MD, FACP, FACC, FESC, FSCAI, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Via WA Mozart, 9, 37040 Legnago, Verona, Italy. Tel: +3903471912016; Fax: +39044220164; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Usually the literature results for device-closure of patent oval foramen concern a single type of device or different devices implanted without anatomical preferences. We propose a strategy of device type and selection based on intra-cardiac echocardiography measurements of inter-atrial septum characteristics.

Methods

We prospectively enrolled 100 consecutive patients with amean age of 43 plus or minus 15.5 years, 68 females, who had been referred to our centre for catheter-based closure of inter-atrial shunts over a 48-month period. On the basis of intra-cardiac echocardiography findings the operators selected the Amplatzer Occluder family (AGA Medical Corporation) or the Premere Closure System (St Jude Medical Inc.). Determinants of the selection process were presence and extension of atrial septal aneurysm, tunnel length, rims length, and thickness, presence of additional fenestrations.

Results

According on intra-cardiac echocardiography study, 26 patients have a long channel patent oval foramen, 44 patients had a large atrial septal aneurysm (more than four RL), 24 patients had a moderate atrial septal aneurysm (more than two RL but less than four right-to-left), and six patients had hypertrophic rims. Thus, the Amplatzer PFO Occluder was selected in 24 patients, the Amplatzer ASD Cribriform Occluder in 44 patients, and the Premere device in 32 cases. No aortic erosions, device thrombosis, or recurrent ischaemic cerebral events were observed. Pre-discharge and follow-up occlusion rates were 91% and 96%, respectively.

Conclusions

Our study suggested that such strategy driven from identification and measurements of the right atrium and inter-atrial septum components resulted in low complications and high-success rates, mandatory conditions when facing with otherwise healthy subjects, such as the patients with patent oval foramen.

Keywords

Cardiac anatomyinterventionalstroke
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 2 , April 2010 , pp. 144 - 149
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cifarelli, A, Musto, C, Parma, A, et al. Long-term outcome of transcatheter patent foramen ovale closure in patients with paradoxical embolism. Int J Cardiol 2009, [epub ahead of print].Google ScholarPubMed
2.Spies, C, Reissmann, U, Timmermanns, I, Schräder, R. Comparison of contemporary devices used for transcatheter patent foramen ovale closure. J Invasive Cardiol 2008; 20: 442–447.Google ScholarPubMed
3.von Bardeleben, RS, Richter, C, Otto, J, et al. Long term follow up after percutaneous closure of patent oval foramen in 357 patients with paradoxical embolism: difference in occlusion systems and influence of atrial septum aneurysm. Int J Cardiol 2009; 134: 33–41.CrossRefGoogle ScholarPubMed
4.Rigatelli, G, Cardaioli, P, Dell’Avvocata, F, et al. The association of different right atrium anatomical-functional characteristics correlates with the risk of paradoxical stroke: an intracardiac echocardiographic study. J Interv Cardiol 2008; 21: 357–362.CrossRefGoogle ScholarPubMed
5.Sloan, MA, Alexandrov, AV, Tegeler, CH. Therapeutics and technology assessment subcommittee echocardiography of the American Academy of neurology. Assessment: transcranial Doppler ultrasonography: report of the therapeutics and technology assessment subcommittee echocardiography of the American Academy of Neurology. Neurology 2004; 62: 1468–1481.CrossRefGoogle ScholarPubMed
6.Lang, RM, Bierig, M, Devereux, RB, et al. American society of echocardiography’s nomenclature and standards committee echocardiography; task force on chamber quantification; American college of cardiology echocardiography committee echocardiography; American heart association; European association of echocardiography, European society of cardiology. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79–108.CrossRefGoogle Scholar
7.Rigatelli, G, Hijazi, ZM. Intracardiac echocardiography in cardiovascular catheter-based interventions: different devices for different purposes. J Invasive Cardiol 2006; 18: 225–233.Google ScholarPubMed
8.Olivares-Reyes, A, Chan, S, Lazar, EJ, Bandlamudi, K, Narla, V, Ong, K. Atrial septal aneurysm: a new classification in two hundred five adults. J Am Soc Echocardiogr 1997; 10: 644–656.CrossRefGoogle ScholarPubMed
9.Zanchetta, M, Rigatelli, G, Pedon, L, Zennaro, M, Carrozza, A, Onorato, E. Catheter closure of perforated secundum atrial septal defect under intracardiac echocardiographic guidance using a single amplatzer device: feasibility of a new method. J Invasive Cardiol 2005; 17: 262–265.Google ScholarPubMed
10.Boutin, C, Musewe, NN, Smallhorn, JF, et al. Echocardiographic follow-up of atrial septal defect after catheter closure by double-umbrella device. Circulation 1993; 88: 621–627.CrossRefGoogle ScholarPubMed
11.Hein, R, Buscheck, F, Fischer, E, et al. Atrial and ventricular septal defects can safely be closed by percutaneous intervention. J Interv Cardiol 2005; 18: 515–522.CrossRefGoogle ScholarPubMed
12.Krumsdorf, U, Ostermayer, S, Billinger, K, et al. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1000 consecutive patients. J Am Coll Cardiol 2004; 43: 302–309.CrossRefGoogle Scholar
13.Amin, Z, Hijazi, ZM, Bass, JL, Cheatham, JP, Hellenbrand, WE, Kleinman, CS. Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects: review of registry of complications and recommendations to minimise future risk. Catheter Cardiovasc Interv 2004; 63: 496–502.CrossRefGoogle ScholarPubMed
14.Prokselj, K, Kozelj, M, Zadnik, V, Podnar, T. Echocardiographic characteristics of secundum-type atrial septal defects in adult patients: implications for percutaneous closure using Amplatzer septal occluders. J Am Soc Echocardiogr 2004; 17: 1167–1172.CrossRefGoogle ScholarPubMed