Patent foramen ovale surgery
Patent Foramen Ovale Microchapters
Patent foramen ovale surgery On the Web
American Roentgen Ray Society Images of Patent foramen ovale surgery
There is lack of consensus regarding the effectiveness of either surgical or percutaneous closure of patent foramen ovale. Insufficient evidence to recommend device closure for a first stroke exists. PFO closure may be considered for recurrent cryptogenic stroke and high-risk patent foramen ovale (PFO) (atrial septal aneurysm). Some randomized controlled trials to compare the relative effectiveness of medical therapy versus percutaneous closure are on way and in future might be helpful in making therapeutic decisions.
Treatment Options in Patent Foramen Ovale with Recurrent Strokes|Trial Supportive Data for Percutaneous Closure in PFO with Recurrent Stroke
- Surgical closure of patent foramen ovale is uncommon these days especially after development of percutaneous device closure. Some systematic reviews done to compare medical versus percutaneous closure, found that the rate of recurrent strokes with medical treatment (5.2%) is greater than that with percutaneous closure (1.3%)  . However, the results of these systematic reviews should be interpreted carefully, because there was lack of uniformity in the selection criteria, duration of follow up and end points in the individual studies that were used for the systematic review. Some randomized controlled trials to compare the relative effectiveness of medical therapy versus percutaneous closure are on way and in future might be helpful in making therapeutic decisions.
- Studies have found that incidences of major complications such as death, major haemorrhage, need for emergency surgery, tamponade, and fatal pulmonary embolism are low (1.5–2.3%) after percutaneous closure . However, other studies found that some complications like valvular regurgitation , residual shunt, atrial fibrillation are increased after percutaneous closure, especially with larger devices . This is a cause for concern as these post-surgical complications are added risk factors for future stroke event.
The Ampltazer septal occluder (ASO) is the most commonly used device as it allows closure of large cavities, is easy to implant, and boasts high success rates. As an instrument, the ASO consists of two self-expandable round discs connected to each other with a 4-mm waist, made up of 0.004-0.005 nitinol wire mesh filled with dacron fabric. Implantation of the device is relatively easy. The prevalence of residual defect is low. The disadvantages are a thick profile of the device and concern related to a large amount of nitinol (a nickel-titanium compound) in the device and consequent potential for nickel toxicity.
Federal Drug Administration (FDA) Approved Percutaneous Devices for Patent Foramen Ovale Closure
- CardioSEAL Septal Occlusion System - Double umbrella-shaped permanent implant.
- Amplatzer PFO Occluder - Self-expanding wire mesh with double discs. Once the device is in place, tissue grows over it, and it becomes part of the atrial septum.
International Guidelines for Prevention of Recurrent Cerebral Embolism in Patent Foramen Ovale
American Academy of Neurology Guidelines for Prevention of Recurrent Cerebral Embolism in Patent Foramen Ovale (DO NOT EDIT)
1) There is insufficient evidence regarding the effectiveness of either surgical or percutaneous closure of PFO (Level U).
Rating of Recommendations
U = Data inadequate or conflicting. Given current knowledge, treatment (test predictor) is unproven.
American Heart Association/American Stroke Association Guidelines for Prevention of Recurrent Cerebral Embolism in Patent Foramen Ovale (DO NOT EDIT)
Insufficient data exist to make a recommendation about PFO closure in patients with a first stroke and a PFO. PFO closure may be considered for patients with recurrent cryptogenic stroke despite medical therapy. (Level of Evidence: C)
European Stroke Organization Guidelines for Prevention of Recurrent Cerebral Embolism in Patent Foramen Ovale (DO NOT EDIT)
- ↑ 1.0 1.1 European Stroke Organisation (ESO) Executive Committee. ESO Writing Committee (2008). "Guidelines for management of ischaemic stroke and transient ischaemic attack 2008.". Cerebrovasc Dis 25 (5): 457-507. doi:10.1159/000131083. PMID 18477843.
- ↑ 2.0 2.1 Khairy P, O'Donnell CP, Landzberg MJ (2003). "Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli: a systematic review.". Ann Intern Med 139 (9): 753-60. PMID 14597460.
- ↑ 3.0 3.1 Homma S, Sacco RL (2005). "Patent foramen ovale and stroke.". Circulation 112 (7): 1063-72. doi:10.1161/CIRCULATIONAHA.104.524371. PMID 16103257.
- ↑ 4.0 4.1 Wöhrle J (2006). "Closure of patent foramen ovale after cryptogenic stroke.". Lancet 368 (9533): 350-2. doi:10.1016/S0140-6736(06)69087-9. PMID 16876648.
- ↑ Schoen SP, Boscheri A, Lange SA, Braun MU, Fuhrmann J, Kappert U et al. (2008). "Incidence of aortic valve regurgitation and outcome after percutaneous closure of atrial septal defects and patent foramen ovale.". Heart 94 (7): 844-7. doi:10.1136/hrt.2007.132662. PMID 18070946.
- ↑ Staubach S, Steinberg DH, Zimmermann W, Wawra N, Wilson N, Wunderlich N et al. (2009). "New onset atrial fibrillation after patent foramen ovale closure.". Catheter Cardiovasc Interv 74 (6): 889-95. doi:10.1002/ccd.22172. PMID 19626689.
- ↑ Alaeddini J, Feghali G, Jenkins S, Ramee S, White C, Abi-Samra F (2006). "Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale.". J Invasive Cardiol 18 (8): 365-8. PMID 16877784.
- ↑ Messé SR, Silverman IE, Kizer JR, Homma S, Zahn C, Gronseth G et al. (2004). "Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology.". Neurology 62 (7): 1042-50. PMID 15078999.
- ↑ Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC et al. (2011). "Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association.". Stroke 42 (1): 227-76. doi:10.1161/STR.0b013e3181f7d043. PMID 20966421.
There is no pharmaceutical or device industry support for this site and we need your viewer supported Donations | Editorial Board | Governance | Licensing | Disclaimers | Avoid Plagiarism | Policies