Abstract 21075: Percutaneous Closure of Patent Foramen Ovale for Systemic Hypoxemia: Patient Characteristics and Results in 104 Patients
Right to left shunting (RTLS) across a PFO is a known but uncommon cause of hypoxemia. The role of closure is not well studied. We present the largest, single-center retrospective study of patients undergoing PFO closure for systemic hypoxemia. From 2004 to 2009, 104 patients underwent closure of a PFO for systemic hypoxemia at UCH with 47 undergoing cardiopulmonary evaluation at NJH. Patients had symptomatic hypoxemia out of proportion to lung disease, despite optimal medical therapy. RTLS was demonstrated by agitated saline echocardiography at rest, with Valsalva maneuver, cough, or exercise. The decision to close a PFO and device selection was made at the time of catheterization. Exclusion criteria were emergent closure (n=4) or non-cardiac death prior to follow-up (n=3). Procedural success was defined as PFO closure without a major complication and mild or no residual RTLS at 6 month follow-up. Clinical success was a composite of an improvement in NYHA functional class, symptomatic improvement alone, or decreased oxygen requirement. The Wilcoxon signed-rank test was used to evaluate improvement in NYHA Class after PFO closure. Oxygen requirement was evaluated using McNemar's test. A logistic regression model was used to identify predictors of improvement in NYHA class. A review of 97 patients was conducted with 100% follow-up at 235 ± 319 days. Mean age was 59 ± 19 years with 47 males and 50 females. Amplatzer Cribriform ASD Occluder (n=92) or Helex Septal Occluder (n=5) devices were used. No major complications were encountered. One patient had residual severe shunt at 6 month follow-up. One patient experienced a late TIA due to device thrombosis, 5 months after PFO closure. The safety and mechanical effectiveness of PFO closure in shunt-related hypoxemia are clearly shown in this study. Clinical success is achieved in a majority of patients. These data will guide the design of a multicenter, randomized trial to elucidate the role of PFO closure for hypoxemia due to shunting.
- Adult congenital heart disease
- Heart septal defects
- Interventional cardiology
- Heart catheterization
- © 2010 by American Heart Association, Inc.