Page 9 - Journal of Structural Heart Disease Volume 3, Issue 5

Original Research Article
Journal of Structural Heart Disease, October 2017, Volume 3, Issue 5:135-140
DOI: https://doi.org/10.12945/j.jshd.2017.018.17
Received: April 08, 2017 Accepted: April 17, 2017 Published online: October 2017
Percutaneous Closure of Patent Foramen
Ovale or Atrial Septal Defect in the Presence
of Thrombophilia
Subrata Kar, DO1, Nabil Noureddin, MD1, Jamil Aboulhosn, MD2, Yakov Mahmzi, BS1, Alexandra Coluzzi, BS1, Jonathan M. Tobis, MD1*
1 Program of Interventional Cardiology, David Ge en School of Medicine, University of California Los Angeles, Los Angeles, California, USA
2 Ahmanson/UCLA Adult Congenital Heart Disease Center, David Ge en School of Medicine, University of California Los Angeles, Los Angeles, California, USA
Abstract
Background: Some thrombophilic patients have been excluded from clinical trials of septal defect closure due to the presumed higher risk of thrombus forma- tion. The purpose of this study was to assess whether pre-existing thrombophilia predisposes patients to ad- verse events after percutaneous patent foramen ovale (PFO) or atrial septal defect (ASD) closure.
Methods: A retrospective observational study was performed including 147 patients with thrombophil- ia who were referred for percutaneous PFO or ASD closure for cryptogenic stroke or transient ischemic attack (n = 104, 70.7%), migraine (n = 30, 20.4%), pe- ripheral embolism (n = 5, 3.4%), right ventricular en- largement (n = 2, 1.4%), desaturation (n = 1, 0.7%), or a combination of diagnoses (n = 4, 2.7%). Post-proce- dure follow-up included 3-6 month clinical evaluation, chart review, or phone call.
Results: Of the 147 patients (46 ± 13 years of age, fol- low-up of 43.5 ± 34.7 months) who met the inclusion cri- teria, 142 had a PFO (96.6%), and 5 had an ASD (3.4%); 69 (46.9%) underwent closure. Of the closure patients, 1 (1.4%) developed thrombus (Amplatzer ASO device). There were no cases of endocarditis or device erosion. One patient had a stroke post-closure (1.4%). Of the 80 women with stroke, TIA, or peripheral arterial embo- lism, 52 (65.0%) were taking oral contraceptive pills or hormone replacement therapy at the time of the event.
Conclusions: Percutaneous closure can be safely per- formed without a signi cant risk of thrombus formation despite the presence of thrombophilic factors. The most common reversible thrombophilic factor was ex- ogenous estrogen compounds (43%), whereas 57% of patients had irreversible thrombophilic disorders. Copyright © 2017 Science International Corp.
Key Words
Atrial septal defect • Patent foramen ovale • Thrombophilia • Stroke • Percutaneous closure
Introduction
Intra-cardiac defects such as patent foramen ovale (PFO) or atrial septal defect (ASD) are often closed to prevent cryptogenic stroke, transient ischemic attack (TIA), migraine, or right ventricular enlargement. The risk of thrombotic formation on the device may be increased in patients with thrombophilia or proth- rombotic states [1-3]. The safety and recurrence rate of thrombotic events after PFO or ASD closure in pa- tients with thrombophilia or prothrombotic states are unknown because such patients are excluded from randomized clinical trials. This retrospective observa- tional study of percutaneous PFO or ASD closure in
*Corresponding author:
Jonathan M. Tobis, MD
Program of Interventional Cardiology, David Ge en School of Medicine
757 Westwood Plaza,
Los Angeles, California 90095, USA
Tel.: +1 310 794 4797; Fax: +1 310 267 0384; E-Mail: jtobis@mednet.ucla.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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http://structuralheartdisease.org/