Page 11 - Journal of Structural Heart Disease Volume 3, Issue 5

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Original Scienti c Article
Table 2. List of hypercoagulable conditions (total = 147 patients)
Table 3. Patient groups, closure indications, and closure devices used (total of 147 patients)
Hypercoagulable Conditions (18 categories)
n (%)
Patients Groups
n (%)
§OCP
‡HRT
Pregnant
†CA
Autoimmune Disease
§OCP and ‡HRT
Medication induced (‡HRT, §OCP, or †CA medications)
Beta-thalassemia minor
Elevated lipoprotein A
Protein C or S de ciency
Factor V Leiden mutation Prothrombin gene mutation Elevated Factor VIII level
*APS or anti-cardiolipin antibody Anti-thrombin 3 de ciency Beta-2-glycoprotein-1 antibody Presumed hypercoagulable state Hyperhomocysteinemia Thrombocytosis
Combined thrombophilia
46 (31.3%) 26 (16.3%) 6 (4.1%) 4 (2.7%) 27 (18.4%) 70 (47.6%) 72 (49.0%)
1 (0.7%)
1 (0.7%) 12 (8.2%) 12 (8.2%) 16 (10.9%) 1 (0.7%) 25 (17.0%) 3 (2.0%)
9 (6.1%) 1 (0.7%) 3 (2.0%) 2 (1.4%) 44 (30.0%)
Reversible thrombophilia Irreversible thrombophilia Percutaneous Septal Closure Patients declined closure
Not closure candidate or no *PFO found during cardiac catheterization or Transesoph- ageal Echo
Unsuccessful closure
Closure Indications
Stroke/transient ischemic attack
Migraine with or without aura
Right ventricular enlargement
Deep venous thrombosis, pulmonary embolism, or hypercoagulable state
Peripheral arterial embolism (Toe or popliteal artery embolus)
Desaturation
Combination of indications
Closure Devices Used (total of 69 closures) Amplatzer
Cribiform
Helex
*PFO = patent foramen ovale
61 (41.5%) 86 (58.5%) 69 (46.9%) 43 (29.3%) 34 (23.1%)
1 (0.7%)
n (%)
104 (70.7%) 30 (20.4%) 2 (1.4%) 5 (3.4%)
2 (1.4%)
1 (0.7%) 4 (2.7%) n (%) 34 (49.3%) 2 (2.9%) 33 (47.8%)
*APS = anti-phospholipid syndrome; †CA = cancer; ‡HRT = hormone replacement therapy; §OCP = oral contraceptives
ASD (7.7%). Three of these patients were referred for surgery and excluded. There were 147 subjects (16%) who met the thrombophilia inclusion cri- teria and were referred for percutaneous PFO or ASD closure. Table 1 shows the patient character- istics. Patients were divided into two groups: one with reversible causes of thrombophilia such as OCP/HRT use (n = 57, 38.8%) or gravid state (n = 4, 2.7%) and the other with irreversible causes of thrombophilia as listed in Table 2 (n = 86, 58.5%). In the reversible group, the inciting cause of throm- bophilia such as OCP or HRT use was terminated after the clinical event or hypercoagulable state resolved after fetus delivery. Indications for PFO or ASD closure included a history of previous stroke or TIA (n = 104, 70.7%), migraine (n = 30,
20.4%), peripheral embolism (n = 5, 3.4%), right ventricular enlargement (n = 2, 1.4%), desatura- tion (n = 1, 0.7%), or a combination of diagnoses (n = 4, 2.7%). The study included patients from July 2001 to January 2015.
Of the 147 thrombophilic patients (46 ± 13 years of age), 142 had a PFO (96.6%), 5 had an ASD (3.4%), and 69 (46.9%) underwent closure. Forty-three pa- tients (29.3%) declined percutaneous closure. Thir- ty-three patients (22.4%) were deemed inappropri- ate candidates for closure or were found to have no PFO during cardiac catheterization (n = 8, 5.4%). One patient (0.7%) underwent transesophageal echocar- diography for clari cation of a suspected PFO, which revealed the absence of a PFO. All septal closures were successful except 1 ASD case (1.4%), which was
Kar, S. et al.
Septal Defect Closure in Thrombophilia