Percutaneous closure strategy in patients with patent foramen ovale and coexisting small atrial septal defect: a...

In transcatheter closure of patent foramen ovale (PFO) associated with cryptogenic stroke (CS), a small coexisting atrial septal defect (ASD) can serve as a potential source of residual shunting if not adequately addressed. We conducted a retrospective study of 14 patients with PFO and coexisting ASD who underwent transcatheter closure between December 2019 and May 2025. The first five patients treated with Amplatzer™ PFO Occluder demonstrated residual right-to-left shunting graded ≥ 3 at one-year follow-up. Following the introduction of the GORE® CARDIOFORM Septal Occluder (GSO) and GORE® CARDIOFORM ASD Occluder (GCA) in Japan, nine additional patients were treated. Among the eight patients who completed one-year follow-up, seven exhibited no significant residual right-to-left shunting (i.e., grade < 3). No recurrent strokes or device-related complications occurred in any of the 14 patients. This single-center study highlights the importance of appropriate device selection in managing PFO and coexisting ASD. In this anatomically complex subset, the use of GSO and GCA was associated with more favorable anatomical closure outcomes. However, these results should be interpreted cautiously in light of the limited number of cases and the non-comparative study design.