International Journal of Cardiology
Volume 134, Issue 1 , Pages 33-41 , 1 May 2009

Long term follow up after percutaneous closure of PFO in 357 patients with paradoxical embolism: Difference in occlusion systems and influence of atrial septum aneurysm

  • Ralph Stephan von Bardeleben

      Affiliations

    • 2nd Medical Clinic, Johannes Gutenberg-University Mainz, Germany
  • ,
  • Claudia Richter

      Affiliations

    • 2nd Medical Clinic, Johannes Gutenberg-University Mainz, Germany
  • ,
  • Julia Otto

      Affiliations

    • 2nd Medical Clinic, Johannes Gutenberg-University Mainz, Germany
  • ,
  • Ludmilla Himmrich

      Affiliations

    • 2nd Medical Clinic, Johannes Gutenberg-University Mainz, Germany
  • ,
  • Renate Schnabel

      Affiliations

    • 2nd Medical Clinic, Johannes Gutenberg-University Mainz, Germany
  • ,
  • Christoph Kampmann

      Affiliations

    • Department for Pediatrics Johannes Gutenberg-University Mainz, Germany
  • ,
  • Hans-Jürgen Rupprecht

      Affiliations

    • 2nd Medical Clinic, Health and Care Center Rüsselsheim, Germany
  • ,
  • Jürgen Marx

      Affiliations

    • Department for Neurology Johannes Gutenberg-University Mainz, Germany
  • ,
  • Gerhard Hommel

      Affiliations

    • Institute for Medical Biometry, Epidemiology and Informatics (IMBEI), Johannes Gutenberg-University Mainz, Germany
  • ,
  • Thomas Münzel

      Affiliations

    • 2nd Medical Clinic, Johannes Gutenberg-University Mainz, Germany
  • ,
  • Georg Horstick

      Affiliations

    • 2nd Medical Clinic, Johannes Gutenberg-University Mainz, Germany
    • Corresponding Author InformationCorresponding author. Johannes Gutenberg Universität Mainz, II Medizinische Klinik, Langenbeckstrasse 1, 55131 Mainz, Germany. Tel.: +49 173-6896497; fax: +49 6131 17 6692.

Received 21 June 2007 ,Revised 6 February 2008 ,Accepted 27 February 2008.

References 

  1. Lechat P, Mas JL, Lascault G, Loron P, Theard M, Klimczac M, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318:1148–1152
  2. Webster MW, Chancellor AM, Smith HJ, Swift DL, Sharpe DN, Bass NM, et al. Patent foramen ovale in young stroke patients. Lancet. 1988;2:11–12
  3. Sacco RL, Foulkes MA, Mohr JP, Wolf PA, Hier DB, Price TR. Determinants of early recurrence of cerebral infarction. The Stroke Data Bank. Stroke. 1989;20:983–989
  4. Job FP, Ringelstein EB, Grafen Y, Flachskampf FA, Doherty C, Stockmanns A, et al. Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients. Am J Cardiol. 1994;74:381–384
  5. Pearson AC, Nagelhout D, Castello R, Gomez CR, Labovitz AJ. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. J Am Coll Cardiol. 1991;18:1223–1229
  6. Cabanes L, Mas JL, Cohen A, Amarenco P, Cabanes PA, Oubary P, et al. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography. Stroke. 1993;24:1865–1873
  7. Agmon Y, Khandheria BK, Meissner I, Gentile F, Whisnant JP, Sicks JD, et al. Frequency of atrial septal aneurysms in patients with cerebral ischemic events. Circulation. 1999;99:1942–1944
  8. Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55:1172–1179
  9. Lamy C, Giannesini C, Zuber M, Arquizan C, Meder JF, Trystram D, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial septal aneurysm. Stroke. 2002;33:706–711
  10. Meissner I, Khandheria BK, Heit JA, Petty GW, Sheps SG, Schwartz GL, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol. 2006;47:440–445
  11. Di Tullio MR, Sacco RL, Sciacca RR, Jin Z, Homma S. Patent foramen ovale and the risk of ischemic stroke in a multiethnic population. J Am Coll Cardiol. 2007;49:797–802
  12. Mas JL, Zuber M. Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack. French Study Group on Patent Foramen Ovale and Atrial Septal Aneurysm. Am Heart J. 1995;130:1083–1088
  13. Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med. 2001;345:1740–1746
  14. Messe SR, Silverman IE, Kizer JR, Homma S, Zahn C, Gronseth G, et al. Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004;62:1042–1050
  15. Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001;345:1444–1451
  16. Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation. 2002;105:2625–2631
  17. Bruch L, Parsi A, Grad MO, Rux S, Burmeister T, Krebs H, et al. Transcatheter closure of interatrial communications for secondary prevention of paradoxical embolism: single-center experience. Circulation. 2002;105:2845–2848
  18. Braun M, Gliech V, Boscheri A, Schoen S, Gahn G, Reichmann H, et al. Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism. Periprocedural safety and mid-term follow-up results of three different device occluder systems. Eur Heart J. 2004;25:424–430
  19. Wahl A, Krumsdorf U, Meier B, Sievert H, Ostermayer S, Billinger K, et al. Transcatheter treatment of atrial septal aneurysm associated with patent foramen ovale for prevention of recurrent paradoxical embolism in high-risk patients. J Am Coll Cardiol. 2005;45:377–380
  20. Krumsdorf U, Ostermayer S, Billinger K, Trepels T, Zadan E, Horvath K, et al. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol. 2004;43:302–309
  21. Martin F, Sanchez PL, Doherty E, Colon Hernandez PJ, Delgado G, Inglessis I, et al. Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism. Circulation. 2002;106:1121–1126
  22. Windecker S, Wahl A, Nedeltchev K, Arnold M, Schwerzmann M, Seiler C, et al. Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke. J Am Coll Cardiol. 2004;44:750–758
  23. Markus HS, Punter M. Can transcranial Doppler discriminate between solid and gaseous microemboli? Assessment of a dual-frequency transducer system. Stroke. 2005;36:1731–1734
  24. Schuchlenz HW, Saurer G, Weihs W, Rehak P. Persisting eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events. J Am Soc Echocardiogr. 2004;17:231–233
  25. Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP. Atrial anatomy in non-cardioembolic stroke patients: effect of medical therapy. J Am Coll Cardiol. 2003;42:1066–1072
  26. Brandt RR, Neumann T, Neuzner J, Rau M, Faude I, Hamm CW. Transcatheter closure of atrial septal defect and patent foramen ovale in adult patients using the Amplatzer occlusion device: no evidence for thrombus deposition with antiplatelet agents. J Am Soc Echocardiogr. 2002;15:1094–1098
  27. Anzai H, Child J, Natterson B, Krivokapich J, Fishbein MC, Chan VK, et al. Incidence of thrombus formation on the CardioSEAL and the Amplatzer interatrial closure devices. Am J Cardiol. 2004;93:426–431
  28. Bogousslavsky J, Garazi S, Jeanrenaud X, Aebischer N, Van Melle G. Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group. Neurology. 1996;46:1301–1305
  29. Landzberg MJ, Khairy P. Indications for the closure of patent foramen ovale. Heart. 2004;90:219–224
  30. De Castro S, Cartoni D, Fiorelli M, Rasura M, Anzini A, Zanette EM, et al. Morphological and functional characteristics of patent foramen ovale and their embolic implications. Stroke. 2000;31:2407–2413
  31. CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet. 1997;349:1641–1649
  32. International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet. 1997;349:1569–1581
  33. Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke. 2004;35:528–532
  34. Hankey GJ. Ongoing and planned trials of antiplatelet therapy in the acute and long-term management of patients with ischaemic brain syndromes: setting a new standard of care. Cerebrovasc Dis. 2004;17(Suppl 3):11–16
  35. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331–337
  36. Schuchlenz HW, Weihs W, Berghold A, Lechner A, Schmidt R. Secondary prevention after cryptogenic cerebrovascular events in patients with patent foramen ovale. Int J Cardiol. 2005;101:77–82
  37. Homma S, Di Tullio MR, Sacco RL, Sciacca RR, Smith C, Mohr JP. Surgical closure of patent foramen ovale in cryptogenic stroke patients. Stroke. 1997;28:2376–2381
  38. Ruchat P, Bogousslavsky J, Hurni M, Fischer AP, Jeanrenaud X, von Segesser LK. Systematic surgical closure of patent foramen ovale in selected patients with cerebrovascular events due to paradoxical embolism. Early results of a preliminary study. Eur J Cardiothorac Surg. 1997;11:824–827
  39. Dearani JA, Ugurlu BS, Danielson GK, Daly RC, McGregor CG, Mullany CJ, et al. Surgical patent foramen ovale closure for prevention of paradoxical embolism-related cerebrovascular ischemic events. Circulation. 1999;100:Ii171–175
  40. Klotz S, Tjan TD, Berendes E, Droste DW, Scheld HH, Schmid C. Surgical closure of combined symptomatic patent foramen ovale and atrial septum aneurysm for prevention of recurrent cerebral emboli. J Card Surg. 2005;20:370–374
  41. Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, Lock JE. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation. 1992;86:1902–1908
  42. Sievert H, Babic UU, Hausdorf G, Schneider M, Hopp HW, Pfeiffer D, et al. Transcatheter closure of atrial septal defect and patent foramen ovale with ASDOS device (a multi-institutional European trial). Am J Cardiol. 1998;82:1405–1413
  43. Windecker S, Wahl A, Chatterjee T, Garachemani A, Eberli FR, Seiler C, et al. Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. Circulation. 2000;101:893–898
  44. Spies C, Strasheim R, Timmermanns I, Schraeder R. Patent foramen ovale closure in patients with cryptogenic thrombo-embolic events using the Cardia PFO occluder. Eur Heart J. 2006;27:365–371

PII: S0167-5273(08)00465-8

doi: 10.1016/j.ijcard.2008.02.031

International Journal of Cardiology
Volume 134, Issue 1 , Pages 33-41 , 1 May 2009