Magnetic Resonance Imaging After Percutaneous Closure of a Patent Foramen Ovale
A 51-year-old patient presented with a second episode of transient loss of vision. A persistently patent foramen ovale (PFO) was diagnosed with a transesophageal echocardiogram, and percutaneous closure with an implantable device (PfoStar, Cardia, Inc) was done. The PfoStar is a catheter implantable device consisting of 2 polyvinyl sheets spread by 2 crossed nitinol wires. The axis of the left and the right nitinol strut are shifted by 45 degrees (Figure 1). After successful implantation of a 30/3 mm device, cine MRI was performed. Quantitative flow measurements, as well as right and left ventricular voltmetry, revealed no evidence of a postprocedural shunt. The 4-chamber view (Figure 2) and a short-axis section through the atria (Figure 3) show the occluding device in situ. Only a minimal gap between the atrial septum and the device was observed. Imaging was performed on a 1.5T whole-body scanner (Intera CV, Philips Medical Systems) using single-breathhold, steady-state free precession sequences with cardiac gating. This technique allows a high spatial and temporal resolution (1.6 mm2 in-plane resolution; 23 phases per heart cycle).
Percutaneous closure of a PFO has recently become an established method to reduce the risk of thrombembolic events. 1 In clinical routine, follow-up is performed by transesophageal echocardiography. MRI seems to be a useful, noninvasive, diagnostic tool to evaluate patients after interventional closure of a PFO.
Movie versions of Figures 2 and 3 are available in an online only Data Supplement at http://www.circulationaha.org
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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