This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Meier, B. PubMed PubMed Citation Articles by Meier, B. Related Collections Catheter-based coronary and valvular interventions: other Embolic stroke

(Circulation. 2009;120:1837-1841.)
© 2009 American Heart Association, Inc.

Clinician Update

Catheter-Based Closure of the Patent Foramen Ovale

Bernhard Meier, MD

From Cardiology, Cardiovascular Department, University Hospital, Bern, Switzerland.

Correspondence to Bernhard Meier, MD, Professor and Chairman of Cardiology, Cardiovascular Department, University Hospital, 3010 Bern, Switzerland. E-mail bernhard.meier@insel.ch

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case presentation: A 34-year-old woman was admitted for chest pain lasting 5 hours. She had been in excellent health except for migraine attacks with rare aura that kept her away from work about twice a month. She took no medication except for birth control pills. The ECG was unrevealing, but cardiac biomarkers were elevated. Emergency cardiac catheterization showed an occluded small left circumflex coronary artery (Figure 1) and a corresponding small akinetic area in the left ventriculogram. No attempt at coronary recanalization was made because the symptoms had abated, the injured myocardium was akinetic, and there were no collaterals. However, a catheter was introduced into the right atrium, and contrast medium injection proved the suspected patent foramen ovale (PFO; Figure 2 and Movies I and II in the online-only Data Supplement). An Amplatzer PFO occluder was implanted in <10 minutes. The patient was discharged 36 hours later after her cardiac biomarkers had normalized.

View larger version (151K):   Figure 1. Right anterior oblique view of the left coronary artery showing an abrupt occlusion (presumably embolic) of a small left circumflex coronary artery (arrow).

View larger version (83K):   Figure 2. Left, Angiographic proof of a PFO (dashed arrow) by contrast medium injection at the PFO entrance in the right atrium (RA). Right, Situation after implantation of an Amplatzer 25-mm PFO occluder (left atrium [LA] disk, 25 mm; RA disk, 18 mm). See also Movies I and II in the online-only Data Supplement. SS indicates septum secundum; SP, septum primum.

Several lessons are to be gleaned from this case: . . . [Full Text of this Article]