Page 30 - Journal of Structural Heart Disease Volume 5, Issue 2

Case Report
Journal of Structural Heart Disease, April 2019, Volume 5, Issue 2:43-47
DOI: https://doi.org/10.12945/j.jshd.2019.019.18
Received: June 05, 2018 Accepted: July 03, 2018 Published online: April 2019
Patent Foramen Ovale Closure using Cardioform Occluder Device Through the Right Internal Jugular Vein for Primary Prevention (First in Man): Importance of a Multidisciplinary Team
Jad Al Danaf, MD, MPH*, Abdulfattah Saidi, MD, Brigham Smith, MD, Anwar Tandar, MD Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
Abstract
Percutaneous transcatheter closure of Patent Fora- men Ovale (PFO) is usually performed via the femoral vein but in certain circumstances this approach may not be possible necessitating the need for an alterna- tive access. The right internal jugular vein has been successfully utilized in these cases. We are presenting the first successful PFO closure using a Cardioform Oc- cluder Device to close a PFO as a primary prevention approach in a patient with a large inferior vena cava thrombus from renal cell carcinoma.
Copyright © 2019 Science International Corp.
Key Words
PFO • Peri-operative risk • IVC thrombus • Cardioform device • Right internal jugular vein • Primary prevention • Multidisciplinary approach
Introduction
Transcatheter closure of patent foramen ovale (PFO) is a standard and growing procedure at many health care centers. Recently, three promising ran- domized clinical trials: CLOSE [1], Gore REDUCE [2] and RESPECT [3]; and an updated meta-analysis [4] support PFO closure in patients with cryptogenic
stroke compared to medical therapy advocating for an update to the current guidelines. In addition, there are still no primary prevention recommendations for PFO closure. The procedure is usually easily per- formed with a trans-femoral venous approach given the anatomy of the inferior vena cava (IVC) and the interatrial septum (IAS). However, certain conditions such as an IVC thrombus as in our case may preclude using this access, hence the need for alternative ap- proach such as via the right internal jugular vein (R-IJ).
PFO closure using the R-IJ vein has been success- fully reported in several case reports using different occluder devices such as a 25-mm Multi-fenestrated ASD occluder [5] and a Figula Flex II PFO 23/25 mm occluder device [6].
We present the first case to the best of our knowl- edge of closing a PFO using a 30mm Cardioform Oc- cluder Device (COD) from the R-IJ vein in a patient without a history of stroke with an IVC thrombus from renal cell carcinoma (RCC).
Patients with RCC and IVC tumor related thrombus have poor prognosis and radical nephrectomy with thrombectomy is considered to be potentially curative [6]. In our case, the patient had a PFO (Figure 1) and symptomatic severe AS that increased her surgical risk of major adverse cardiovascular events and death.
* Corresponding Author:
Jad Al Danaf, MD, MPH
Division of Cardiovascular Medicine, Department of Internal Medicine University of Utah
30 N. 1900E, Room 4A100, Salt Lake City, UT 84112, USA
Tel.: +1 801 587 2451; Fax: +1 801 581 7735; E-Mail: jad.aldanaf@hsc.utah.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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