Original Scientific Article
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Journal of Structural Heart Disease, October 2017, Volume 3, Issue 5:135-140
DOI: 10.12945/j.jshd.2017.018.17
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 Geffen School of Medicine at UCLA, Los Angeles, California, USA
2 Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, 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 formation. The purpose of this study was to assess whether pre-existing thrombophilia predisposes patients to adverse events after percutaneous patent foramen ovale (PFO) or atrial septal defect (ASD) closure.
Methods: A retrospective observational study was performed including 147 patients with thrombophilia 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%), peripheral embolism (n = 5, 3.4%), right ventricular enlargement (n = 2, 1.4%), desaturation (n = 1, 0.7%), or a combination of diagnoses (n = 4, 2.7%). Post-procedure follow-up included 3-6 month clinical evaluation, chart review, or phone call.
Results: Of the 147 patients (46 ± 13 years of age, follow- up of 43.5 ± 34.7 months) who met the inclusion criteria, 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 embolism, 52 (65.0%) were taking oral contraceptive pills or hormone replacement therapy at the time of the event.
Conclusions: Percutaneous closure can be safely performed without a significant risk of thrombus formation despite the presence of thrombophilic factors. The most common reversible thrombophilic factor was exogenous estrogen compounds (43%), whereas 57% of patients had irreversible thrombophilic disorders.
Cite this article as: Kar S, Noureddin N, Aboulhosn J, Mahmzi Y, Coluzzi A, Tobis JM. Percutaneous Closure of Patent Foramen Ovale or Atrial Septal Defect in the Presence of Thrombophilia. Structural Heart Disease 2017;3(5):135-140. DOI: 10.12945/j.jshd.2017.018.17
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Original Scientific Article
Journal of Structural Heart Disease, October 2017, Volume 3, Issue 5:135-140
DOI: 10.12945/j.jshd.2017.018.17
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 Geffen School of Medicine at UCLA, Los Angeles, California, USA
2 Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, 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 formation. The purpose of this study was to assess whether pre-existing thrombophilia predisposes patients to adverse events after percutaneous patent foramen ovale (PFO) or atrial septal defect (ASD) closure.
Methods: A retrospective observational study was performed including 147 patients with thrombophilia 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%), peripheral embolism (n = 5, 3.4%), right ventricular enlargement (n = 2, 1.4%), desaturation (n = 1, 0.7%), or a combination of diagnoses (n = 4, 2.7%). Post-procedure follow-up included 3-6 month clinical evaluation, chart review, or phone call.
Results: Of the 147 patients (46 ± 13 years of age, follow- up of 43.5 ± 34.7 months) who met the inclusion criteria, 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 embolism, 52 (65.0%) were taking oral contraceptive pills or hormone replacement therapy at the time of the event.
Conclusions: Percutaneous closure can be safely performed without a significant risk of thrombus formation despite the presence of thrombophilic factors. The most common reversible thrombophilic factor was exogenous estrogen compounds (43%), whereas 57% of patients had irreversible thrombophilic disorders.
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Cite this article as: Kar S, Noureddin N, Aboulhosn J, Mahmzi Y, Coluzzi A, Tobis JM. Percutaneous Closure of Patent Foramen Ovale or Atrial Septal Defect in the Presence of Thrombophilia. Structural Heart Disease 2017;3(5):135-140. DOI: 10.12945/j.jshd.2017.018.17
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