SpringerLink
Log in

Relationship between patent foramen ovale anatomical features and residual shunt after patent foramen ovale closure

  • Original Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

Transcatheter closure of patent foramen ovale (PFO) is an effective strategy for preventing recurrence of paradoxical embolism. However, PFO closure is often associated with residual shunt, which is a risk of recurrent stroke. This study aimed to evaluate the relationship between the anatomical features of PFO and residual shunt. The degree of residual shunt and its relationship with the anatomical features of PFO were evaluated in 106 patients who underwent PFO closure at our institution between March 2011 and January 2022 and in whom contrast transthoracic echocardiography was performed 1 year later. The mean PFO tunnel length was 9.3 ± 3.6 mm and the mean PFO height was 3.2 ± 2.2 mm. Atrial septal aneurysm (ASA) was found in 37 patients. After PFO closure, residual shunt was observed in 28 patients (grade 1, n = 8; grade 2, n = 16; grade 3, n = 3; grade 4, n = 1). Univariate logistic analysis identified ASA to be associated with residual shunt (odds ratio 2.78, 95% confidence interval 1.14 to 6.79; p = 0.024). There was no association of residual shunt with the size of the PFO, the length of PFO tunnel, or the size of the device used for closure. Two of four patients with a large residual shunt of grade 3 or grade 4 were found to have device size mismatch. Residual shunt after PFO closure was observed in a quarter of patients and was related to the presence of ASA. A few patients had a large residual shunt due to the device size mismatch.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ASA:

Atrial septal aneurysm

PFO:

Patent foramen ovale

RL:

Right to left

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

References

  1. Diener HC, Hankey GJ. Primary and secondary prevention of ischemic stroke and cerebral hemorrhage: JACC focus seminar. J Am Coll Cardiol. 2020;75:1804–18.

    Article  PubMed  Google Scholar 

  2. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial—TOAST: trial of Org 10172 in acute stroke treatment. Stroke. 1993;24:35–41.

    Article  PubMed  Google Scholar 

  3. Lee PH, Song JK, Kim JS, Heo R, Lee S, Kim DH, et al. Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO trial. J Am Coll Cardiol. 2018;71:2335–42.

    Article  PubMed  Google Scholar 

  4. Nakayama R, Takaya Y, Akagi T, Watanabe N, Ikeda M, Nakagawa K, et al. Identification of high-risk patent foramen ovale associated with cryptogenic stroke: development of a scoring system. J Am Soc Echocardiogr. 2019;32:811–6.

    Article  PubMed  Google Scholar 

  5. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Tirschwell DL, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med. 2017;377:1022–32.

    Article  PubMed  Google Scholar 

  6. Sondergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Thomassen L, et al. Patent foramen ovale closure or amtiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017;377:1033–42.

    Article  PubMed  Google Scholar 

  7. Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Chatellier G, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377:1011–21.

    Article  CAS  PubMed  Google Scholar 

  8. Deng W, Yin S, McMullin D, Inglessis-Azuaje I, Elmariah S, Hung J, et al. Residual shunt after patent foramen ovale closure and long-term stroke recurrence: a prospective cohort study. Ann Intern Med. 2020;172:3717–25.

    Article  Google Scholar 

  9. Suligoj NC, Rojko M, Suligoj B, Zorc M, Kar S, Noc M. Long-term transesophageal echocardiography after patent foramen ovale closure by BioSTAR and Amplatzer patent foramen ovale occluders. Catheter Cardiovasc Interv. 2020;95:349–54.

    Article  PubMed  Google Scholar 

  10. Gevorgyan Fleming R, Kumar P, West B, Noureddin N, Rusheen J, Aboulhosn J, et al. Comparison of residual shunt rate and complications across 6 different closure devices for patent foramen ovale. Catheter Cardiovasc Interv. 2020;95:365–72.

    Article  PubMed  Google Scholar 

  11. Matsumura K, Gevorgyan R, Mangels D, Masoomi R, Mojadidi MK, Tobis J. Comparison of residual shunt rates in five devices used to treat patent foramen ovale. Catheter Cardiovasc Interv. 2014;84:455–63.

    Article  PubMed  Google Scholar 

  12. Greutmann M, Greutmann-Yantiri M, Kretschmar O, Senn O, Roffi M, Jenni R, et al. Percutaneous PFO closure with Amplatzer PFO occluder: predictors of residual shunts at 6 months follow-up. Congenit Heart Dis. 2009;4:252–7.

    Article  PubMed  Google Scholar 

  13. Moon J, Kim M, Oh PC, Shin DH, Park HM, Jo YY, et al. Residual shunt after patent foramen ovale device closure in patients with cryptogenic stroke: serial bubble contrast transesophageal echocardiography data. J Stroke Cerebrovasc Dis. 2019;28:347–53.

    Article  PubMed  Google Scholar 

  14. Sorensen SG, Aguilar H, McKnight WK, Thomas H, Muhlestein JB. Transcranial Doppler quantification of residual shunt after percutaneous patent foramen ovale closure. Comparison of two devices. J Interv Cardiol. 2010;23:575–80.

    Article  PubMed  Google Scholar 

  15. Marchese N, Pacilli MA, Inchingolo V, Fanelli R, Loperfido F, Vigna C. Residual shunt after percutaneous closure of patent foramen ovale with AMPLATZER occluder devices-influence of anatomic features: a transcranial Doppler and intracardiac echocardiography study. EuroIntervention. 2013;9:382–8.

    Article  PubMed  Google Scholar 

  16. Takaya Y, Nakayama R, Akagi T, Yokohama F, Miki T, Nakagawa K, et al. Importance of saline contrast transthoracic echocardiography for evaluating large right-to-left shunt in patent foramen ovale associated with cryptogenic stroke. Int J Cardiovasc Imaging. 2022;38:515–20.

    Article  PubMed  Google Scholar 

  17. Takaya Y, Watanabe N, Ikeda M, Akagi T, Nakayama R, Nakagawa K, et al. Importance of abdominal compression valsalva maneuver and microbubble grading in contrast transthoracic echocardiography for detecting patent foramen ovale. J Am Soc Echocardiogr. 2020;33:201–6.

    Article  PubMed  Google Scholar 

  18. Katsianos E, Oikonomou E, Kalogeras K, Manousaki A, Kalantzis C, Pantelidis P, et al. Residual right-to-left-shunt following transcatheter patent foramen ovale closure: the role of antithrombotic treatment. Curr Pharm Des. 2022;28:3305–12.

    Article  CAS  PubMed  Google Scholar 

  19. Susuri N, Obeid S, Ulmi M, Siontis GCM, Wahl A, Windecker S, et al. Second transcatheter closure for residual shunt following percutaneous closure of patent foramen ovale. EuroIntervention. 2017;13:858–66.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Rie Nakayama, Yoichi Takaya, Teiji Akagi, Mitsutaka Nakashima, Takashi Miki, Koji Nakagawa, Norihisa Toh & Kazufumi Nakamura

  2. Division of Medical Support, Okayama University Hospital, Okayama, Japan

    Rika Takemoto & Madoka Haruna

Authors
  1. Rie Nakayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoichi Takaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Teiji Akagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rika Takemoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Madoka Haruna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mitsutaka Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takashi Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Koji Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Norihisa Toh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazufumi Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoichi Takaya.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakayama, R., Takaya, Y., Akagi, T. et al. Relationship between patent foramen ovale anatomical features and residual shunt after patent foramen ovale closure. Cardiovasc Interv and Ther 39, 200–206 (2024). https://doi.org/10.1007/s12928-023-00979-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-023-00979-y

Keywords

Search

Navigation