Percutaneous closure of patent foramen ovale and atrial septal defect
A case report
A 67-year old man with a hemodynamically significant type secundum atrial septal defect (ASD), large patent foramen ovale (PFO) and significant septal aneurism presented with shortness of breath and limited exercise tolerance. There was no evidence of additional structural abnormalities nor significant coronary artery disease. Simultaneous percutaneous closure of both defects was planned. Since the wire could have been passed only through PFO and the second wire not through the ASD, only PFO was closed with 35 mm Amplatz PFO occluder. After 3 months, which served for tissue ingrowth of Amplatz PFO occluder and aneurism stabilization, ASD located in posterior-inferior part of fossa ovalis documented by three-dimensional transesophageal echocardiography (3D-TEE) was easily crossed and successfully closed with a 12 mm Amplatz ASD occluder. Stable position without unwanted interference between the devices was obtained. There was noresidual shunting on color Doppler and no bubble shunting during Valsalva maneuver. Within 6 months after the procedure, symptoms significantly improved and right heart chambers decreased. 3D-TEE revealed both devices in good position with only trivial shunting through PFO occluder documented by color Doppler.
Dolenc J, Koželj M, Prokšelj K. Najpogostejše zmote pri obravnavi odraslih bolnikov s prirojenimi srčnimi napakami. Zdrav Vestn. 2012;81:312–9.
Berger F, Ewert P. Atrial septal defect: waiting for symptoms remains an unsolved medical anachronism. Eur Heart J. 2011 Mar;32(5):531–4. https://doi.org/10.1093/eurheartj/ehq377 PMID:20971748
Humenberger M, Rosenhek R, Gabriel H, Rader F, Heger M, Klaar U, et al. Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J. 2011 Mar;32(5):553–60. https://doi.org/10.1093/eurheartj/ehq352 PMID:20943671
Dolenc J, Cerar A, Cvijić M, Prokšelj K, Mirta K. Long-term follow up after transcatheter closure of atrial septal defect and patent foramen ovale in adults. Zdrav Vestn. 2013;82:809–17.
Carroll JD, Saver JL, Thaler DE, Smalling RW, Berry S, MacDonald LA, et al.; RESPECT Investigators. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med. 2013 Mar;368(12):1092–100. https://doi.org/10.1056/NEJMoa1301440 PMID:23514286
Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, et al.; PC Trial Investigators. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med. 2013 Mar;368(12):1083–91. https://doi.org/10.1056/NEJMoa1211716 PMID:23514285
Furlan AJ, Reisman M, Massaro J, Mauri L, Adams H, Albers GW, et al.; CLOSURE I Investigators. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med. 2012 Mar;366(11):991–9. https://doi.org/10.1056/NEJMoa1009639 PMID:22417252
Webb G, Gatzoulis MA. Atrial septal defects in the adult: recent progress and overview. Circulation. 2006 Oct;114(15):1645–53. https://doi.org/10.1161/CIRCULATIONAHA.105.592055 PMID:17030704
Černič Šuligoj N, Zorc M, Grad A, Kar S, Noč M. Perkutano zapiranje ovalnega okna-izkušnje z novejšimi tipi zapiral. Slov Kardiol. 2011;8:13–7.
Černič Šuligoj N, Zorc M, Kar S, Noč M. Perkutano zapiranje defekta preddvornega pretina tipa sekundum pri odraslih bolnikih- naše izkušnje. Slov Kardiol. 2012;9:4–9.
Noc M, Cernic Suligoj N, Zorc M, Kar S. In-tunnel closure of patent foramen ovale with FlatStent. Kardiol Pol. 2015 Mar 3. https://doi.org/10.5603/KP.a2015.0026.
Copyright (c) 2020 Slovenian Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.