Page 16 - Journal of Structural Heart Disease Volume 2, Issue 5

Original Research Article
Journal of Structural Heart Disease, October 2016, Volume 2, Issue 5:217-223
DOI: http://dx.doi.org/10.12945/j.jshd.2016.009.15
Received: August 10, 2015 Accepted: August 30, 2015 Published online: October 2016
A Practical Scoring System to Select Optimally Sized Devices for Percutaneous Patent Foramen Ovale Closure
Joseph M. Venturini, MD*, Elizabeth M. Retzer, MD, J. Raider Estrada, MD, Anuj Mediratta, MD, Janet Friant, MSN, Sandeep Nathan, MD, Jonathan D. Paul, MD, John Blair, MD,
Roberto M. Lang, MD, Atman P. Shah, MD
Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
Abstract
Background: Patent foramen ovale (PFO) has been linked to cryptogenic stroke, and closure has been reported to improve clinical outcomes. However, there are no clear guidelines to direct device sizing. This study sought to use patient characteristics and echocardiographic nd- ings to create a prediction score for device sizing. Methods: This was a retrospective review of patients un- dergoing percutaneous PFO closure at our institution be- tween July 2010 and December 2014. Demographic and clinical characteristics were recorded, and all pre- and in- traprocedural echocardiography results were evaluated. Results: Thirty-six patients underwent percutaneous PFO closure during the study period. All procedures were performed using an Amplatzer Septal Occluder “Cribriform” (ASOC) device in one of three disc diame- ters: 25, 30, or 35 mm. Closure was indicated for crypto- genic stroke/transient ischemic attack in 75% of cases. Every case (100%) was successful with durable shunt correction at the 6-month follow-up without complica- tions of erosion or device embolization. The presence of atrial septal aneurysm (ASA) (p = 0.027) and PFO tunnel length >10 mm (p = 0.038) were independently associated with increased device size. A scoring system of 1 point for male sex, 1 point for ASA, and 1 point for PFO tunnel >10 mm long was associated with the size of closure device implanted (p = 0.006).
Conclusions: A simple scoring system may be used to select an optimally sized device for percutaneous PFO closure using the ASOC device.
Copyright © 2016 Science International Corp.
Key Words
Patent foramen ovale • Device sizing • Percutaneous closure
Introduction
A patent foramen ovale (PFO) is a remnant of fetal circulation. In utero, placental blood from the inferior vena cava is directed toward the interatrial septum and across the foramen ovale, facilitating ow of oxygenated blood into systemic circulation. At birth, decreased pulmonary artery and right heart pressures result in a reversal of the right atrium-to-left atrium pressure gradient across the foramen ovale. This change in pressure pushes the septum primum (left atrial ap) against the septum secundum (muscular atrial septum). These structures typically fuse together in the rst two years of life. Incomplete fusion results in a slit-like defect that is present in approximately 25% of adults and is referred to as a PFO [1, 2]. The pres- ence of PFO has been associated with an increased risk for paradoxical embolism resulting in stroke or ob- structing peripheral embolism [3-7]. PFO has also been linked to increased risk for migraine headaches, hy- poxemia, decompression syndrome in divers, and the platypnea-orthodeoxia syndrome [8-10]. The severity of these associated illnesses, particularly the poten- tially devastating complications of cryptogenic stroke, has increased interest in PFO closure.
* Corresponding Author:
Atman P. Shah, MD
University of Chicago Medicine
5841 S. Maryland Ave, M C6080, Chicago, IL 60637, USA
Tel.: +1 773 702 1372; Fax: +1 773 702 0241; E-Mail: ashah@bsd.uchicago.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2016 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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