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Updated: Jun 5, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Redo patent foramen ovale closure for persistent residual right-to-left shunting
Ronak Rajani1, Lorraine Lee, Manav Sohal
1Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK.
Insights
Redoing patent foramen ovale (PFO) closure with a second device is feasible for patients with residual shunting after initial closure. This approach can be effective for persistent symptoms and neurological event risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Structural Heart Disease
Background:
- Percutaneous patent foramen ovale (PFO) closure aims for >90% success in eliminating right-left shunting.
- Residual shunting occurs in up to 10% of patients post-PFO closure, with optimal management strategies unclear.
Observation:
- This study reports on four cases of successful redo PFO closure using a second device.
- Patients underwent initial PFO closure for various reasons including cerebrovascular events, migraine with aura, and systemic embolization.
- All patients had moderate residual shunting at >6-month follow-up and persistent disabling symptoms or increased neurological event risk.
Findings:
- Redo PFO closure was technically feasible in all reported cases, irrespective of the initial device used.
- The decision for redo closure was based on persistent disabling symptoms and elevated neurological event risk despite medical management.
- A second percutaneous interatrial septal occluder proved feasible for managing significant residual shunting post-initial PFO closure.
Implications:
- This suggests that a second device closure is a viable option for select patients with residual shunting after PFO closure.
- Further research may elucidate the long-term efficacy and safety of redo PFO closure.
- These findings offer a potential solution for patients experiencing ongoing symptoms or risks due to residual shunting.
Aims:
The success rate in eliminating a right-left-shunting following percutaneous patent foramen ovale closure is estimated to be > 90%. However up to 10% of patients may have residual shunting following initial closure. Little is known as to the optimum treatment strategy for these patients. We report four cases in which to redo patent foramen ovale closure was possible with a second device.
Methods And Results:
At our institution during 2008-2009, 101 patients underwent PFO closure: 81 patients (80%) underwent PFO closure for cerebrovascular events, 12 patients (12%) for migraine with aura, eight patients for systemic embolisation (8%), three patients (3%) for decompression illness and one patient underwent PFO closure for platypnea-orthodexia syndrome. Irrespective of the initial device, redo closure was technically feasible in all cases. All patients had at least a moderate residual shunt evident on echocardiographic evaluation at > 6-month follow-up. The patients in the current study were offered a redo procedure based on the presence of persistent disabling symptoms, as well as increased risk of neurological events, despite adequate antiplatelet therapy and anticoagulation.
Conclusions:
A second percutaneous interatrial septal occluder is feasible in those patients with significant residual shunting following initial closure.
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