Use of the NobleStitch™ EL for the treatment of patients with residual right-to-left shunt following device closure of PFO

Updates on Patent Foramen Ovale (PFO) Closure

PURPOSE OF REVIEW

Patent foramen ovale (PFO) has been previously linked to left circulation thromboembolism and stroke. This review article aims to discuss the latest evidence, updated societal guidelines, diagnostic algorithms and novel therapeutic devices for PFO closure.

RECENT FINDINGS

PFO closure for cryptogenic stroke and systemic embolization is supported by a large body of evidence and has a strong societal recommendation. Limited data are available for platypnea-orthodeoxia syndrome, although closure appears to be beneficial. Current data do not support routine closure for migraines and decompression Illness. Development of heart-brain teams can improve identification of patients most likely to benefit from closure, utilizing a combination of imaging test and risk score algorithms. Multiple novel devices aiming at reducing complications and improving the long-term impact of current available devices are being evaluated. PFO closure has significantly progressed over the last years, with new data supporting its superiority in reducing risk of recurrent embolic stroke in patients with PFO-related stroke. Additional clinical data are required to provide further refinements on patient selection and guidance on treatment of specific subgroups.

Traumatic Atrial Septal Defect Repair via Primary Endovascular Suture Method: Case Report and Operative Technique

We report a case of a 20-year-old male with no prior medical history who was found to have an atrial septal defect on echocardiography following a motor vehicle accident (MVA). The patient underwent primary percutaneous defect closure using the NobleStitch EL (Heartstitch, Fountain Valley, California) cardiovascular suturing system with intra-operative Doppler echocardiogram showing no residual shunt or color flow. There were no operative complications. At five months follow-up, the patient reported no symptoms from the procedure. In the case of traumatic atrial septal defect repair, the NobleStitch EL system may be utilized as an alternative to open heart surgery.

Recent advances in catheter devices for patent foramen ovale closure

INTRODUCTION

Over the last 5 years, the armamentarium of the interventional cardiologist dealing with percutaneous closure of patent foramen ovale (PFO) has been enriched by some novel devices and further improvements of existing ones that have or promise to increase the safety and effective closure rate of PFO patients.

AREAS COVERED

This review presents and discusses recent advancements in device design and composition from both technical and clinical perspectives.

EXPERT OPINION

Device technology is continuously evolving. The recent modification of delivery system, device hooking, and composition, as well as the advent of new bioabsorbable materials, is promising to make percutaneous PFO closure devices safer. The search for more effectiveness with possibly less metal behind is still ongoing.