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Clinical research

Redo patent foramen ovale closure for persistent residual right-to-left shunting

Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom

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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