Control/Tracking Number: 05-A-1261-CRF
Activity: Abstracts
Current Date/Time: 6/9/2005 3:30:41 PM
Late Failure of Percutaneous PFO Closure: Mechanism
of Failure and Treatment Options
Sherman G Sorensen1, James W Long2,
Steven C Horton1, Peter J Casterella1,
Laurie Raleigh3, Heather Aguilar3, Donald
L Lappé1, Joseph B Muhlestein2, 1Utah Heart Clinic and LDS Hospital Cardiology,
Salt Lake City, UT;2LDS Hospital Cardiology, Salt
Lake City, UT;3Utah Heart Clinic, Salt Lake City,
UT
BACKGROUND: Percutaneous catheter closure
of patent foramen ovale (PFO) is an increasingly accepted
treatment option for stroke prevention that has good procedural
safety and early results. However, late results due to device
failure are unknown. Differences of device design, device
materials, implantation technique, healing effect, or PFO
morphologic features may influence long-term outcomes.
METHODS: From 2001-2005, 950 PFO closure procedures
were performed with 261 CardioSEAL® (CS) and 689 Amplatzer®
PFO (AMP) devices. Implant imaging used transesophageal echocardiography
in 430 patients (pts) and intra-cardiac echocardiography in
520 pts. In our early experience with the CS device, pts with
long PFO tunnel (> 10 mm) and large PFO with atrial septal
aneurysm (ASA) were usually treated by the transeptal technique.
Eleven (1.0%) pts (3 AMP, 8 CS) required evaluation and treatment
for persistent or late failure of PFO closure (range: 9-26
months post closure). Evaluation of the pts was prompted by
transient ischemic attack (TIA) in 4 pts, recurrent complex
migrane (migrane with TIA symptoms) in 3 pts, and persistent
severe shunt in 4 pts.
RESULTS: There were 3 AMP pts that had severe persistent
shunting. All had ASA, long tunnel, and closure with a 35mm
AMP device. Catheter treatment was not feasible and all were
treated medically without event. Of the 8 CS pts, 5 developed
progressive shunt worsening from implant to symptom presentation.
All CS failure patients were closed by the transeptal technique,
had a tunnel of 15-27 mm, had a ASA, and received a large
device (40mm= 4pts, 33mm= 4pts). Device retraction and arm
splay was defined by echocardiography in all and by surgical
removal in 4 pts. There were 4 pts treated by second device
placement (second device: AMP PFO= 2pts, AMP SO= 2 pts).
CONCLUSIONS: We concluded that 1) Late PFO
closure failure is uncommon and is multi-factorial; 2) Healing
retraction is related to transeptal placement and device type,
but is treatable by second device placement; 3) AMP failure
due to non incorporation is difficult to treat percutaneously;
and 4) Complex PFO morphology may be better treated with devices
resulting in better defect filling and device apposition.
AUTHOR DISCLOSURE BLOCK: S.G. SORENSEN, None.
Category (Complete): Congenital Heart Disease
Presentation Format (Complete): Poster
Keywords (Complete): Shunt Closure: ASD,
PFO, etc ; Congenital Heart Disease
Status: Complete
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