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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
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Effect of Residual Interatrial Shunt on Migraine Burden After Transcatheter Closure of Patent Foramen Ovale

Eyal Ben-Assa1, Pablo Rengifo-Moreno2, Rasha Al-Bawardy3

  • 1Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

JACC. Cardiovascular Interventions
|February 8, 2020
PubMed
Abstract

Insights

Transcatheter patent foramen ovale (PFO) closure significantly improved migraine burden long-term in 87% of patients. Aura presence predicted symptom abolishment, while absence of residual shunt predicted significant migraine burden reduction.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Migraine symptom improvement after PFO closure is reported, but randomized trials have yielded inconclusive results.
  • Patent Foramen Ovale (PFO) is a common cardiac anomaly that may be associated with neurological conditions like migraine.

Purpose of the Study:

  • To evaluate the long-term efficacy of transcatheter PFO closure for migraineurs, with or without aura.
  • To investigate the impact of residual right-to-left shunt on migraine symptom improvement post-PFO closure.

Main Methods:

  • Retrospective analysis of 110 migraineurs who underwent transcatheter PFO closure.
  • Assessment of migraine burden using a validated questionnaire, measuring frequency, duration, and overall burden.
  • Long-term follow-up to assess symptom improvement, defined as >50% reduction or complete abolishment of migraine burden.

Main Results:

  • Significant long-term improvement in migraine symptoms was observed in 87% of patients (>50% reduction in burden) and 48% experienced complete symptom abolishment.
  • Migraine with aura was associated with a higher likelihood of complete symptom abolishment (OR: 4.30).
  • Absence of residual right-to-left shunt at 6 months post-closure predicted significant improvement in migraine burden (OR: 4.60).

Conclusions:

  • Transcatheter PFO closure offers significant long-term benefits for migraineurs, reducing overall migraine burden.
  • The presence of aura is a positive predictor for complete migraine symptom resolution post-PFO closure.
  • Eliminating residual shunting after PFO closure is crucial for achieving substantial migraine burden reduction.
Keywords:
migrainepatent foramen ovaleright-to-left shunt

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