Transcranial Doppler quantification of residual shunt after percutaneous patent foramen ovale closure: correlation of device efficacy with intracardiac anatomic measures

Journal of Interventional Cardiology
Sherman G SorensenSusan Horn

Abstract

Percutaneous, mechanical closure of defects of the atrial septum fails to completely resolve shunting in up to 20% of cases. Little is known about the factors associated with device failure. We measured the left atrial opening (X), right atrial opening (Z), tunnel length (Y), septum secundum, device-septum primum separation, and tunnel compressibility of the patent foramen ovale (PFO) in 301 patients with cryptogenic neurological events, PFO anatomy, and severe Valsalva shunting (Spencer Grade 5-5+). All patients then underwent percutaneous closure with the GORE®HELEX Septal Occluder device and were evaluated at 3 months for residual shunt by transcranial Doppler (TCD). Severe residual Valsalva shunt (TCD Grade 5-5+) was found at 3 months in 21 of 301 (7%) patients. X, Y, and Z were associated with failure with a high degree of statistical significance, whereas the width of the septum secundum, device-septum primum separation, and tunnel compressibility were not. An unanticipated finding was that 14 of 35 (40%) patients sized with a large balloon failed compared with 9 of 280 (3%) sized with a small balloon (P < 0.0001). In the multivariate logistic regression model, X (P = < 0.0001) and balloon size (P < 0.0001) were both stro...Continue Reading

References

Aug 21, 2003·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Kavitha ChintalaThomas J Forbes
Aug 18, 2004·Journal of the American College of Cardiology·Stephan WindeckerBernhard Meier
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Aug 28, 2010·Journal of Interventional Cardiology·Sherman G SorensenJoseph B Muhlestein
Sep 18, 2010·JACC. Cardiovascular Imaging·Kuberan PushparajahJohn M Simpson

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Citations

Jul 23, 2013·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Nicola MarcheseCarlo Vigna
Jan 29, 2013·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Luigi CaputiUNKNOWN Italian Patent Foramen Ovale Survey investigators

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