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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Percutaneous closure of patent foramen ovale and valvular function -- effect of the amplatzer occluder
Nazmi Krasniqi1, Janice Roth, Patrick T Siegrist
1Department of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland.
Insights
Patent foramen ovale (PFO) closure with Amplatzer devices is safe but may cause or worsen valvular regurgitation in nearly half of patients. Echocardiography revealed changes in aortic, mitral, and tricuspid valves post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Patent foramen ovale (PFO) closure is common for paradoxical embolism.
- The impact of PFO closure devices on cardiac anatomy and valve function remains unclear.
Purpose of the Study:
- To investigate the effects of percutaneous PFO closure on cardiac chamber anatomy and valvular function.
- To assess changes in aortic, mitral, and tricuspid regurgitation after Amplatzer septal occluder implantation.
Main Methods:
- Retrospective analysis of 177 patients who underwent PFO closure with an Amplatzer septal occluder.
- Echocardiographic examinations performed before and 6 months after the procedure.
- Exclusion of 19 patients due to incomplete follow-up.
Main Results:
- Significant residual shunt was observed in only 6.2% of patients.
- Newly developed or worsened aortic regurgitation (AR) occurred in 9% of patients.
- Mitral regurgitation (MR) developed or worsened in 19%, and tricuspid regurgitation (TR) in 25%.
Conclusions:
- Amplatzer septal occluder implantation is safe and effective for PFO closure.
- The procedure can induce or worsen valvular regurgitation in a significant portion of patients.
- Implanted devices likely alter cardiac chamber structure, necessitating monitoring for valvular function changes.
Background:
Percutaneous closure of the patent foramen ovale (PFO) is a widely used procedure in patients with paradoxical embolism. Whether or not implantation of a PFO closure device alters cardiac chamber anatomy and in turn affects valvular function is unclear.
Methods:
Out of 334 patients who underwent PFO closure between 2002 and 2010, a total of 196 received an Amplatzer septal occluder and were retrospectively analyzed. Nineteen patients (9.7%) were excluded due to an incomplete follow-up. Thus, 177 patients with a mean age of 51 ± 13 years remained for analysis. Clinical and echocardiographic examinations were performed before and 6 month after PFO closure.
Results:
At follow-up, significant residual shunt (>20 microbubbles) was present in only 11 patients (6.2%). Newly developed or worsened aortic regurgitation (AR) was noted in 16 patients (9%), whereas in 2 patients (1%) a previously documented AR had disappeared. In 33 patients (19%), mitral valve regurgitation (MR) developed or worsened, while in 10 patients (5.6%) a previously documented MR was no longer present at follow-up. In 44 patients (25%), tricuspid regurgitation (TR) had developed at follow-up, while in 5 patients (3%) a previously documented TR was no longer visible echocardiographically.
Conclusion:
Implantation of an Amplatzer septal occluder is a safe and effective procedure. However, it can induce or worsen valvular regurgitation in almost half of the patients. Although the degree of regurgitation was generally mild, it is likely that implanted devices alter cardiac chamber structure.
