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Zuin M, Rigatelli G, Bilato C, Bongarzoni A, Zonzin P, Casazza F, Roncon L. Risk of early clinical deterioration and 30-day mortality in pulmonary embolism intermediate-high-risk patients with patent foramen ovale. Intern Emerg Med 2024:10.1007/s11739-024-03657-w. [PMID: 38822190 DOI: 10.1007/s11739-024-03657-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/24/2024] [Indexed: 06/02/2024]
Abstract
We assess the prognostic role of patent foramen ovale (PFO) for the estimation of 30-day mortality and risk of 48-h clinical deterioration since admission, in intermediate-high-risk pulmonary embolism (PE) patients. A post-hoc analysis of intermediate-high-risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (Trial registry: ClinicalTrials.gov; No.: NCT01604538) was performed. The entire cohort was divided according to the presence or absence of PFO after transthoracic echocardiography (TTE) evaluation. Among 450 intermediate-high-risk PE patients (mean age 71.4 ± 13.8 years, 298 males), PFO was diagnosed in 68 (15.1%) cases. A higher mortality rate (29.4% vs. 3.1%, p < 0.001) as well as occurrence of clinical deterioration within 48 h from admission (38.2% vs. 3.6%, p < 0.001) were observed in intermediate-high-risk PE patients with PFO compared to those without multivariate Cox regression analysis showed that the presence of a PFO predicts 30-day mortality (HR: 3.21, 95% CI 3.16-3.27, p < 0.001) and was also associated with a significantly higher risk of 48-h clinical deterioration [HR: 2.24 (95% CI 2.20-2.29), p < 0.0001] in intermediate-high-risk PE patients. The presence of a PFO in intermediate-high-risk PE patients is associated with a higher risk of clinical deterioration within 48 h from admission and 30-day mortality.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, 44124, Ferrara, Italy.
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy.
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Amedeo Bongarzoni
- Department of Cardiology, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Pietro Zonzin
- Department of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Franco Casazza
- Department of Cardiology, San Carlo Borromeo Hospital, Milan, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
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2
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Devos P, Guedeney P, Montalescot G. Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges. J Clin Med 2023; 13:54. [PMID: 38202061 PMCID: PMC10780039 DOI: 10.3390/jcm13010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Patent foramen ovale (PFO) concerns nearly a quarter of the general population and incidence may reach up to 50% in patients with cryptogenic stroke. Recent randomized clinical trials confirmed that percutaneous closure of PFO-related stroke reduces the risk of embolic event recurrence. PFO also comes into play in other pathogenic conditions, such as migraine, decompression sickness or platypnea-orthodeoxia syndrome, where the heterogeneity of patients is high and evidence for closure is less well-documented. In this review, we describe the current indications for PFO percutaneous closure and the remaining challenges, and try to provide future directions regarding the technique and its indications.
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Affiliation(s)
- Perrine Devos
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
- Institut de Cardiologie, Centre Hospitalier Universitaire, Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013 Paris, France
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Jiang H, Cao S, Wang R, Wang S, He Z, Xu X, Yang C, Liu X. In vivo study of a reserved atrial septal puncture area patent foramen ovale occluder. Cardiol Young 2023; 33:1581-1586. [PMID: 36065734 DOI: 10.1017/s1047951122002827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE After patent foramen ovale interventional closure, puncture of the interatrial septum through the occluder is difficult but sometimes needed for further interventional treatment. This paper presents findings from an in vivo experimental study of a reserved atrial septal puncture area patent foramen ovale occluder. MATERIALS AND METHODS A patent foramen ovale model was established in canines using trans-septal puncture of the fossa ovale and high-pressure balloon dilation. Then, patent foramen ovale closure was performed with a reserved atrial septal puncture area and all canines were raised for 3 months. Then, the occluder was crossed and left atrial angiography was performed on the septal area with the occluder. Finally, DSA angiography, echocardiography, and histology were used to evaluate the performance and feasibility of the reserved atrial septal puncture area. RESULTS A patent foramen ovale model was successfully established in 10 canines using the atrial septal puncture method. The average diameter of the patent foramen ovale was 3.77 ±0.19 mm, and the patent foramen ovale was successfully closed in all canines using a reserved atrial septal puncture area. As assessed using transoesophageal echocardiography, the new occluder exhibited an ideal position and was occluded entirely without a residual shunt intraoperatively and postoperatively. A 100% success rate of atrial septum puncture was achieved across the new occluder. The occluders were completely endothelialised 3 months post-implantation. CONCLUSIONS The reserved atrial septal puncture area was effective in patent foramen ovale closure and exhibited positive sealing performance and biological compatibility. Trans-septal puncture was feasible and effective after reserved atrial septal puncture area patent foramen ovale closure.
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Affiliation(s)
- Haibin Jiang
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Suyan Cao
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Renrong Wang
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Shuya Wang
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Ziqian He
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Xin Xu
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Chengjian Yang
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
| | - Xiaoxiao Liu
- Department of Cardiology, Wuxi NO. 2 People's Hospital, Nanjing Medical University, Wuxi 214000, Jiangsu, China
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Outcomes of Device Closure of Atrial Septal Defects. CHILDREN-BASEL 2020; 7:children7090111. [PMID: 32854325 PMCID: PMC7552712 DOI: 10.3390/children7090111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
Several devices have been designed and tried over the years to percutaneously close atrial septal defects (ASDs). Most of the devices were first experimented in animal models with subsequent clinical testing in human subjects. Some devices were discontinued or withdrawn from further clinical use for varied reasons and other devices received Food and Drug Administration (FDA) approval with consequent continued usage. The outcomes of both discontinued and currently used devices was presented in some detail. The results of device implantation are generally good when appropriate care and precautions are undertaken. At this time, Amplatzer Septal Occluder is most frequently utilized device for occlusion of secundum ASD around the world.
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Rigatelli G, Zuin M, Nghia NT. Interatrial shunts: technical approaches to percutaneous closure. Expert Rev Med Devices 2018; 15:707-716. [DOI: 10.1080/17434440.2018.1526674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gianluca Rigatelli
- Section of Congenital and Structural Heart Disease Interventions, Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Nguyen Tuong Nghia
- Department of Interventional cardiology, Cho-Ray Hospital, Ho Chi minh City, Vietnam
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Danese A, Stegagno C, Tomelleri G, Piccoli A, Turri G, Carletti M, Variola A, Anselmi M, Mazzucco S, Ferrara A, Bovi P, Micheletti N, Cappellari M, Monaco S, Vassanelli C, Ribichini F. Clinical outcomes of secondary prevention strategies for young patients with cryptogenic stroke and patent foramen ovale. Acta Cardiol 2017; 72:410-418. [PMID: 28705105 DOI: 10.1080/00015385.2017.1307668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background The aim of this study was to compare the immediate and long-term clinical outcomes of medical therapy and percutaneous patent foramen ovale (PFO) closure as secondary prevention strategies in patients younger than 55 years of age presenting with cryptogenic stroke and PFO. Methods Between January 2006 and April 2015, all patients with the diagnosis of cryptogenic stroke and PFO were analysed and prospectively followed. Stroke was confirmed in 159 out of 309 patients (51%). In the remaining cases, other neurological conditions were found and therefore excluded from further analysis. Patients received PFO closure or medical therapy on the basis of a pre-specified algorithm. Primary outcome was the assessment of recurrent ischaemic events at follow-up. Results Percutaneous PFO closure was performed in 77 patients (48%) and 82 (52%) were treated medically. Mean follow-up was 51.6 ± 34.8 months. Two ischaemic strokes occurred in the medical group only (2.4% vs 0%; P = 0.16) and no complications related to the invasive procedure were observed. Conclusions The diagnosis of stroke in patients with PFO could be confirmed in 50% of cases only, underlining the importance of a multidisciplinary evaluation of these patients. A very low ischaemic recurrence rate was observed in the medical therapy group, suggesting that a personalized treatment based on a prespecified diagnostic algorithm yields good clinical results irrespective of the treatment modality. Given the low number of recurrences, larger cohorts may be needed to prove significant differences.
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Affiliation(s)
- Alessandra Danese
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University Hospital of Verona, Italy
| | - Chiara Stegagno
- Division of Neurology, Rovereto Hospital, Trento, Verona, Italy
| | | | - Anna Piccoli
- Division of Cardiology, Department of Medicine, University Hospital of Verona
| | - Giulia Turri
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University Hospital of Verona, Italy
| | - Monica Carletti
- Division of Cardiology, Department of Medicine, University Hospital of Verona
| | - Andrea Variola
- Division of Cardiology, Department of Medicine, University Hospital of Verona
| | | | - Sara Mazzucco
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University Hospital of Verona, Italy
- Stroke prevention research unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Angela Ferrara
- Division of Cardiology, Department of Medicine, University Hospital of Verona
| | - Paolo Bovi
- Department of Neurosciences, Stroke Unit, Verona Hospital, Verona, Italy
| | - Nicola Micheletti
- Department of Neurosciences, Stroke Unit, Verona Hospital, Verona, Italy
| | - Manuel Cappellari
- Department of Neurosciences, Stroke Unit, Verona Hospital, Verona, Italy
| | - Salvatore Monaco
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University Hospital of Verona, Italy
| | - Corrado Vassanelli
- Division of Cardiology, Department of Medicine, University Hospital of Verona
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University Hospital of Verona
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Rigatelli G, Pedon L, Zecchel R, Dell'Avvocata F, Carrozza A, Zennaro M, Mazza A, Zuin M, Russo M, Zanchetta M. Long-Term Outcomes and Complications of Intracardiac Echocardiography-Assisted Patent Foramen Ovale Closure in 1,000 Consecutive Patients. J Interv Cardiol 2016; 29:530-538. [DOI: 10.1111/joic.12325] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease; Cardiovascular Diagnosis and Endoluminal Interventions; Rovigo General Hospital; Rovigo Italy
- Department of Cardiovascular Disease; Cittadella General Hospital; Padua Italy
| | - Luigi Pedon
- Department of Cardiovascular Disease; Cittadella General Hospital; Padua Italy
| | - Roberto Zecchel
- Department of Cardiovascular Disease; Cittadella General Hospital; Padua Italy
| | - Fabio Dell'Avvocata
- Section of Adult Congenital and Adult Heart Disease; Cardiovascular Diagnosis and Endoluminal Interventions; Rovigo General Hospital; Rovigo Italy
| | - Antonio Carrozza
- Department of Cardiovascular Disease; Cittadella General Hospital; Padua Italy
| | - Marco Zennaro
- Department of Cardiovascular Disease; Cittadella General Hospital; Padua Italy
| | - Alberto Mazza
- Department of Medical Sciences; Rovigo General Hospital; Rovigo Italy
| | - Marco Zuin
- Section of Adult Congenital and Adult Heart Disease; Cardiovascular Diagnosis and Endoluminal Interventions; Rovigo General Hospital; Rovigo Italy
| | - Monia Russo
- Department of NeuroSciences; Rovigo General Hospital; Rovigo Italy
| | - Mario Zanchetta
- Department of Cardiovascular Disease; Cittadella General Hospital; Padua Italy
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8
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GEIS NICOLASA, PLEGER SVENT, KATUS HUGOA, HARDT STEFANE. Using the GORE® Septal Occluder (GSO) in Challenging Patent Foramen Ovale (PFO) Anatomies. J Interv Cardiol 2015; 28:190-7. [DOI: 10.1111/joic.12181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- NICOLAS A. GEIS
- Department of Internal Medicine III; University of Heidelberg; Germany
| | - SVEN T. PLEGER
- Department of Internal Medicine III; University of Heidelberg; Germany
| | - HUGO A. KATUS
- Department of Internal Medicine III; University of Heidelberg; Germany
| | - STEFAN E. HARDT
- Department of Internal Medicine III; University of Heidelberg; Germany
- Center of Cardiac and Circulatory Diseases; Bruchsal Germany
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Pathophysiology of paradoxical embolism: evaluation of the role of interatrial septum anatomy based on the intracardiac echocardiography assessment of patients with right-to-left shunting. Cardiol Young 2015; 25:47-55. [PMID: 24103775 DOI: 10.1017/s1047951113001480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Detailed anatomic variants of the interatrial septum in patients with right-to-left shunt and contribution of specific anatomies to the risk of ischaemic recurrences has not yet been comprehensively classified. OBJECTIVE To report a classification of the anatomic variants of the interatrial septum as observed by intracardiac echocardiography and its correlation with clinical and functional characteristics. METHODS We retrospectively reviewed the medical and instrumental data of 520 consecutive patients (mean age 44±15. 5 years, 355 women) who had over a 10-year period undergone intracardiac echocardiography and right-to-left shunt catheter-based closure. The four main features used to analyse were: (a) diameter of the oval fossa, (b) presence and length of the channel, (c) presence and degree of atrial septal aneurysm, and (d) rim thickness. The presence of Eustachian valve was also tabulated. RESULTS The combinations of interatrial septum anatomical features were classified into six main anatomical subgroups. Recurrent embolism, multiple ischaemic foci on brain magnetic resonance imaging, high grade shunt, and permanent shunt before transcatheter closure procedure were associated with type 2, type 4, and type 6. Type 4 anatomical subtype (OR 4.1, 1.5-8 [95% CI], p<0.001) and type 2+presence of Eustachian valve (OR 4.3, 1.6-9 [95% CI], p<0.001) were the strongest predictors of recurrent ischaemic events before transcatheter closure. CONCLUSION Our study showed that interatrial septum anatomy greatly differs among patients with right-to-left shunt, as well as the risk of ischaemic recurrences in different anatomies.
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10
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Aral M, Mullen M. The Flatstent versus the conventional umbrella devices in the percutaneous closure of patent foramen ovale. Catheter Cardiovasc Interv 2014; 85:1058-65. [PMID: 25413379 DOI: 10.1002/ccd.25750] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/15/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patent foramen ovale (PFO) has been associated with paradoxical embolism leading to stroke/transient ischemic attack, migraine, and neurological decompression sickness. In search for the optimal device that would achieve effective clinical closure with minimal complications, a better device selection based on PFO anatomy and improvements in device design is needed. The Flatstent is a new device designed to treat the highly prevalent long-tunnel PFOs from within, minimizing the amount of material left behind in an attempt to reduce device-related complications. The objective is to compare the safety and efficacy of the novel Flatstent versus the conventional umbrella devices in the transcatheter closure of PFO in a nonrandomized, retrospective, single-center study. METHODS Between March 2010 and March 2013, 88 patients underwent PFO closure at The Heart Hospital, London with either the novel Flatstent or one of the four conventionally used umbrella devices (GORE Helex Septal Occluder, Occlutech Figulla Flex, Biostar Septal Occluder, and Amplatzer PFO Occluder) depending on their PFO anatomy. Patients were then evaluated with contrast transthoracic echocardiography (TTE) and/or transoesophageal echocardiography (TOE) at 6 weeks and 1 year after the procedure. The residual shunt and complication rates between the Flatstent and umbrella devices were compared. RESULTS The Flatstent was used in 27 patients (30.7%), whereas 61 patients (69.3%) received one of the four umbrella devices. Primary efficacy point of clinical closure defined as grade 0 or grade 1; residual shunt was achieved in 81.3% in the Flatstent cohort and 80.3% in the umbrella device group at 6 weeks follow-up. At 1 year, the clinical closure rates reached 92.6 and 91.8%. There were two device embolizations, one in each cohort during the immediate postoperative period (<24 hrs), with successful retrieval. One patient in the umbrella device group developed transient atrial fibrillation, which was controlled medically. Event recurrence rate was 0% at 1 year. CONCLUSION No difference was found in closure or complication rates between the Flatstent and the umbrella devices. With appropriate preassessment of the PFO anatomy, the Flatstent works as a safe and effective method of treating the PFO from within the tunnel, especially in those with long-tunnel PFOs. Longer follow-up is needed to establish superiority.
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Affiliation(s)
- Mert Aral
- University College London, Institute of Cardiovascular Science, London, United Kingdom
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11
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Rigatelli G, Dell'Avvocata F, Giordan M, Viceconte N, Osanna RA, Braggion G, Aggio S, Cardaioli P, Chen JP. Usefulness of intracardiac echocardiography with a mechanical probe for catheter-based interventions: a 10-year prospective registry. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:534-543. [PMID: 24898198 DOI: 10.1002/jcu.22177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/04/2014] [Accepted: 05/06/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The clinical outcome benefit of intracardiac echocardiography (ICE) with a mechanical probe during congenital heart disease interventions has not been fully investigated. We reported the long-term results of a prospective registry of interatrial shunt closure guided by mechanical ICE. METHODS We enrolled 537 patients (mean age 48 ± 19.0 years, 378 females) submitted to ICE-aided procedures in a prospective registry over a 10-year period (September 2003-September 2013). All patients underwent transesophageal echocardiography (TEE) before the planned procedure. We evaluated (1) structure identification capability, (2) fossa ovale and interatrial septum component measurement, (3) procedure monitoring capability, (4) procedural and fluoroscopy times, and radiograph dose, (5) probe-related complications. RESULTS ICE was successfully performed and was able to correctly identify the structures previously assessed by TEE in all patients. In 24 patients (4.5%), ICE allowed better anatomy definition than TEE. In 35 other patients (6.5%), ICE identified structures not observed by TEE, which led to change indications to interventions or the operative technique to be used. In 131 patients (24.4%), ICE evaluation led to change the planned device to be implanted. There was only one probe-related complication (0.2%). CONCLUSIONS Mechanical ICE may offer a valid alternative to conventional TEE in guiding congenital heart disease interventional procedures.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
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12
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Feider A, Dhawan R, Chaney M. Percutaneous closure of an incompetent aortic valve using an occluder device in a patient with left ventricular assist device. Anesth Analg 2013; 117:1078-80. [PMID: 24029857 DOI: 10.1213/ane.0b013e3182a4e433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew Feider
- From the Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois
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13
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Abaci A, Unlu S, Alsancak Y, Kaya U, Sezenoz B. Short and long term complications of device closure of atrial septal defect and patent foramen ovale: Meta-analysis of 28,142 patients from 203 studies. Catheter Cardiovasc Interv 2013; 82:1123-38. [DOI: 10.1002/ccd.24875] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/27/2013] [Accepted: 02/09/2013] [Indexed: 01/15/2023]
Affiliation(s)
- Adnan Abaci
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Serkan Unlu
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Yakup Alsancak
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Ulker Kaya
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Burak Sezenoz
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
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14
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Pristipino C, Anzola GP, Ballerini L, Bartorelli A, Cecconi M, Chessa M, Donti A, Gaspardone A, Neri G, Onorato E, Palareti G, Rakar S, Rigatelli G, Santoro G, Toni D, Ussia GP, Violini R. Management of patients with patent foramen ovale and cryptogenic stroke: A collaborative, multidisciplinary, position paper. Catheter Cardiovasc Interv 2013; 82:E38-51. [DOI: 10.1002/ccd.24637] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 08/28/2012] [Indexed: 11/09/2022]
Affiliation(s)
- Christian Pristipino
- Clinical Research Centre and Cardiovascular Department; San Filippo Neri Hospital; Roma; Italy
| | | | - Luigi Ballerini
- Women and Children Department; S. Carlo Hospital; Potenza; Italy
| | - Antonio Bartorelli
- Interventional Cardiology Area; Monzino Cardiology Centre; Milano; Italy
| | - Moreno Cecconi
- Cardiological; Medical and Surgical Sciences Department; University United Hospitals; Ancona; Italy
| | - Massimo Chessa
- Pediatric Cardiology and Adult with Congenital Heart Disease Department; IRCCS Policlinico San Donato; San Donato Milanese; Italy
| | - Andrea Donti
- Pediatric and Developmental Age Cardiology-Bologna University-S. Orsola Malpighi Hospital; Bologna; Italy
| | | | | | | | - Gualtiero Palareti
- Angiology and Coagulation Disorders Unit-S.Orsola Malpighi Hospital; Bologna; Italy
| | - Serena Rakar
- Cardiology Department; Cattinara Hospital; Trieste; Italy
| | - Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Department; Rovigo General Hospital; Rovigo; Italy
| | - Gennaro Santoro
- Cardiology and Vessel Department; Careggi Hospital; Firenze; Italy
| | - Danilo Toni
- Neurology and Psychiatry Department; Sapienza University; Roma; Italy
| | - Gian Paolo Ussia
- Invasive Cardiology Unit, Ferrarotto Hospital; Catania University; Catania; Italy
| | - Roberto Violini
- Interventional Cardiology Unit; San Camillo Hospital; Roma; Italy
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15
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Musto C, Cifarelli A, Fiorilli R, De Felice F, Parma A, Nazzaro MS, Guerra E, Fiorilli F, Violini R. Comparison Between the New Gore Septal and Amplatzer Devices For Transcatheter Closure of Patent Foramen Ovale. Circ J 2013; 77:2922-7. [DOI: 10.1253/circj.cj-13-0565] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Carmine Musto
- Interventional Cardiology Unit, San Camillo Hospital
| | | | | | | | - Antonio Parma
- Interventional Cardiology Unit, San Camillo Hospital
| | | | - Elena Guerra
- Interventional Cardiology Unit, San Camillo Hospital
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16
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A model of multi-disciplinary approach to the diagnosis and treatment of young patients with cryptogenic stroke and patent foramen ovale. Cardiol Young 2012; 22:327-34. [PMID: 22348793 DOI: 10.1017/s1047951112000029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treatment of patent foramen ovale in young patients with stroke is not supported by robust scientific evidence. In clinical practice, a pragmatic approach is needed to guide such therapeutic decisions. This study aims at standardising the diagnostic pathway for stroke patients younger than 55 years of age with a patent foramen ovale; elaborating a therapeutic algorithm; discussing every case in regular interdisciplinary counselling meeting; and setting up a follow-up schedule to assess clinical outcomes. METHODS This is a cohort study on the effect of a standardised treatment of stroke patients with a patent foramen ovale. The primary endpoints include occurrence of recurrent ischaemic events, major bleeding, and device-related complications. The secondary endpoints include drug- or procedure-related side effects, persistence of right-to-left shunt, and persistent cardiac arrhythmia of new onset. RESULTS A total of 103 patients have been enrolled. In all, 51 patients underwent percutaneous atrial septal repair; of these, one had minor post-procedural bleeding. At 12 months, 25% of this group of patients showed a latent I grade shunt, one patient a latent II degree shunt, and none had a persistent shunt. The remaining 52 patients were addressed to medical therapy; one of them experienced stroke recurrences while on medical therapy. CONCLUSIONS This model of implementation of available evidence to clinical practice via a group-based, multi-disciplinary counselling provides a shared and coherent decision pathway and yielded a very low rate of recurrent events and therapy-related complications. This approach could be replicated in specific protocols for other complex or neglected clinical problems.
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Wöhrle J, Bertrand B, Søndergaard L, Turner M, Scholtz W, Ibrahim R, Bourlon F. PFO closuRE and CryptogenIc StrokE (PRECISE) registry: a multi-center, international registry. Clin Res Cardiol 2012; 101:787-93. [PMID: 22487724 DOI: 10.1007/s00392-012-0458-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Premere™ PFO closure device has a special design for closure of patent foramen ovale (PFO) including a flexible distance and angulation between the right and left disc providing minimal septal distortion. The primary objective of the study was to determine the degree of risk for stroke or transient ischemic attack (TIA) in patients after Premere™ PFO closure device implantation. METHODS In this multicenter, prospective observational registry, patients with a clinical indication for PFO closure were included. Patients had a history of stroke or TIA with right to left shunt. Follow-up visits were scheduled according to routine clinical practice. RESULTS In 23 centers from 10 countries, 267 patients with successful device implantation were included. Assessment of right to left shunt after device implantation revealed no residual shunt in 71 %, small shunts in 16.8 %, and moderate or large residual shunts in 5.6 and 6.5 %. With common clinical practice, use of Coumadin or heparin decreased from 27 % pre- to 3 % post-implantation, while use of acetylsalicylic acid or thienopyridines increased from 64 to 95 % and 27 to 80 %, respectively; 18 % of patients were discharged with anti-platelet monotherapy. Mean follow-up was 11 ± 9 months (range 1-24 months). There was no stroke or TIA. During follow-up, there was one sudden death. Atrial fibrillation occurred in five (1.9 %) patients. One (0.4 %) patient with a thrombophilic diathesis developed a thrombus. CONCLUSIONS In this prospective, international, multicenter PRECISE registry, the use of the Premere™ PFO closure device for closure of PFO after stroke or TIA resulted in good clinical results with no recurrent event.
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Affiliation(s)
- Jochen Wöhrle
- Department of Internal Medicine II, Cardiology, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
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Five-year follow-up of transcatheter intracardiac echocardiography-assisted closure of interatrial shunts. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:355-61. [PMID: 21715232 DOI: 10.1016/j.carrev.2011.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 04/18/2011] [Accepted: 04/22/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to prospectively evaluate long-term follow-up results of intracardiac echocardiography-aided transcatheter closure of interatrial shunts in adults. BACKGROUND Intracardiac echocardiography improves the safety and effectiveness of transcatheter device-based closure of interatrial shunts, but its impact on long-term follow-up is unknown. METHODS Over a 5-year period, we prospectively enrolled 258 consecutive patients (mean age 48 ± 19.1 years, 169 females) who had been referred to our centre for catheter-based closure of interatrial shunts. All patients were screened with transesophageal echocardiography before the operation. Eligible patients underwent intracardiac echocardiography study and attempted closure. RESULTS After intracardiac echocardiography study and measurements, 18 patients did not proceed to transcatheter closure due to unsuitable rims, atrial myxoma not diagnosed by preoperative transesophageal echocardiography or inaccurate transesophageal echocardiography measurement of defects more than 40 mm. The remaining 240 patients underwent transcatheter closure: transesophageal echocardiography-planned device type and size were modified in 108 patients (45%). Rates of procedural success, predischarge occlusion and complication were 100%, 94.2% and 5%, respectively. On mean follow-up of 65 ± 15.3 months, the follow-up occlusion rate was 96.5%. There were no cases of aortic/atrial erosion, device thrombosis or atrioventricular valve inferences. CONCLUSIONS Intracardiac echocardiography-guided interatrial shunt transcatheter closure is safe and effective and appears to have excellent long-term results, potentially minimizing the complications resulting from incorrect device selection and sizing.
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Stroke during pregnancy: therapeutic options and role of percutaneous device closure. Heart Lung Circ 2011; 20:538-42. [PMID: 21459671 DOI: 10.1016/j.hlc.2011.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 03/03/2011] [Accepted: 03/07/2011] [Indexed: 01/21/2023]
Abstract
Percutaneous device closure of patent foramen ovale has developed into a therapeutic option for patients with presumed cryptogenic stroke. The appropriate use of these therapies relies on appropriate clinical assessment, as well as an understanding of the potential advantages of certain closure devices. Pregnancy is an uncommon scenario for stroke, but nonetheless represents a hypercoaguable state which may predispose to thromboembolism. We describe a case of stroke during pregnancy treated with percutaneous device closure; the role of, and alternatives to, device closure are discussed, as are specific issues related to device selection and the interventional procedure.
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Rigatelli G, Cardaioli P, Dell'Avvocata F, Giordan M, Chinaglia M. Premere occlusion system for transcatheter patent foramen ovale closure: Mid-term results of a single-center registry. Catheter Cardiovasc Interv 2011; 77:564-9. [DOI: 10.1002/ccd.22713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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