EARLY CLINICAL EXPERIENCE WITH PERCUTANEOUS CLOSURE OF
PATENT FORAMEN OVALE WITH THE AMPLATZER OCCLUDER IN ADULTS. P.C. Hayes *, M.P. Feneley, P.R. Roy,
D.W. Muller. Cardiology Department, St Vincent's
Hospital, Darlinghurst, NSW. OBJECTIVE: Our purpose was to evaluate the clinical
utility and outcomes of percutaneous patent foramen ovale (PFO) closure in
adult patients with unexplained cerebral ischaemic events. METHOD
AND RESULTS: Percutaneous PFO closure
with the Amplatzer occluder was performed successfully in 12 adults (8 male)
between February and December 1999. All
patients had one or more cerebral ischaemic events confirmed on CT or MRI scan
and negative extracranial arterial examination. Their age was 44.6± 10.8 years.
All were in sinus rhythm. A
hypercoagulable predisposition was found in one patient (Factor V Leiden), and
simultaneous pulmonary embolism demonstrated in another. 75% were anticoagulated with warfarin
pre-closure for 8.6± 9.8 (2-30) months.
All patients had right-to-left or bidirectional shunt confirmed by
transoesophageal contrast echocardiography, with 50% having a shunt
demonstrated in the absence of Valsalva
manoeuvre. Eleven 25mm devices and one
28mm device were positioned. The only
procedural complication was transient atrial fibrillation in one patient. Mean procedure time was 58.5±24(20-100)
mins. Mean fluoroscopy time was
8.1±5.1(2.5-18.1) mins. Average
post-procedural length of stay was 1.1 days.
All patients received clopidogrel 75mg for 1 month and aspirin 300mg
daily for 6 months. At 3-6 months
follow-up, only one patient had a positive contrast study during Valsalva
manoeuvre. On clinical follow-up, up to
one year, there were no recurrent ischaemic neurological events, or
device-related complications. CONCLUSIONS: Percutaneous PFO closure in adults can be
performed with minimal morbidity and may prevent recurrent cerebral ischaemia
and the need for long-term anticoagulation.
