Abstract 13494: Recurrent Right to Left Shunt After Presumed Complete Patent Foramen Ovale Closure
Introduction: an increasing number of patients are evaluated for percutaneous patent foramen ovale (PFO) closure, but its long term efficacy is still debated. Contrast transcranial Doppler (cTCD) shows greater sensitivity and better quantification of right-to-left shunts (RLS) compared to transthoracic and transesophageal echocardiography, and allows for direct detection of embolic signals reaching cerebral circulation. Device endothelization should result in sealing of interatrial septum approximately 6 to 12 months after the procedure, but search for RLS after presumed complete closure is not systematically performed nor recommended in guidelines.
Hypothesis: to assess prevalence and clinical relevance of both residual and recurrent shunt after percutaneous PFO closure.
Methods: since July 2001, 168 patients underwent percutaneous PFO closure at our Institution for secondary prevention of paradoxical embolism. They were invited to undergo a cTCD and a clinical interview, as part of our ongoing long-term follow-up protocol.
Results: one hundred and nine patients (60 men and 49 women, mean age at intervention 46.9 [21-70] years) completed the visit up to July 2010 (mean follow-up 4.4 [1.0-8.8] years). RLS was still detectable in 55 patients (50.5%). Sixteen patients (14.7%) showed residual shunt, 9 of whom (8.2%) had mild to severe RLS (International Consensus Criteria grade II-III). Surprisingly, a recurrent shunt after a previous negative cTCD was demonstrated in 39 patients (35.8%), 7 of whom (6.4%) had mild to severe RLS. Three patients, one from each group, presented minor neurological relapses (TIA) during follow-up; one patient died for noncardiac causes. Neither presence nor entity of residual or recurrent RLS was predictive of recurrent paradoxical events.
Conclusions: percutaneous PFO closure doesn't seem to constantly guarantee long term RLS disappearance. The majority of both residual and recurrent RLS is usually mild in grade and uneventful, but reappearance of shunt after presumed complete PFO closure is not unusual, and further studies are needed to define prevalence, clinical management and prognostic impact of recurrent RLS.
- © 2011 by American Heart Association, Inc.