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Hold the door: experience of a non-terciary centre in patent foramen ovale closure
Session:
Posters (Sessão 3 - Écran 7) - Intervenção em cardiopatias congénitas
Speaker:
João Mirinha Luz
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.4 Congenital Heart Disease – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Mirinha Luz; Filipa Ferreira; Ana Cristina Martins; Rita Calé Theotónio; Alexandra Briosa; João Grade Santos; Bárbara Marques Ferreira; Mariana Martinho; Diogo Santos da Cunha; Nazar Ilchyshyn; Oliveira Baltazar; Liliana Pereira; Miguel Rodrigues; Ernesto Pereira; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction and objective:</u></strong> Patent <em>foramen ovale</em> (PFO) is found in 25 to 30% of people. Although a very common finding, only sometimes has clinical significance, such as paradoxical embolism, more often presenting as a stroke. PFO closure is mandatory in these cases, and it can be achieved via percutaneous placement of a closure device, without need for a surgery. Here we present our 10-plus years’ experience in a non-terciary hospital.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods:</u></strong> <span style="background-color:white"><span style="color:#212121">This study assessed clinical data of consecutive patients submitted to PFO closure using an Amplatzer</span></span><span style="background-color:white"><span style="font-family:"Corbel",sans-serif"><span style="color:#212121">®</span></span></span><span style="background-color:white"><span style="color:#212121"> device in a non-terciary hospital. All patients treated were previously discussed in a multidisciplinary team between clinical and interventional cardiology and neurology and a definite etiology for stroke was excluded. The procedural characteristics, safety, and adverse events were retrospectively analyzed.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results:</u></strong> Sixty-five (65) procedures were performed from 2009 to 2022. Mean age at time of the procedure was 53,5 years-old (SD 11,7), the oldest at 76 years-old. The large majority (93,8%) were referred after cerebrovascular events, with a mean RoPE score of 6 (SD 1,78). 84,6% of patients presented at least 1 high-risk characteristic: 67,7% with spontaneous shunt, 46,7% had a tunneled PFO, 32,3% had interatrial septal aneurysm. All procedures were performed under general anesthesia with transesophageal echocardiography (TEE) control. Mean dimension of the defect (balloon sizing) was 8,3 mm (SD 2,3). Successful closure was achieved in 95,4% of the patients, with a low rate of periprocedural complications (3,1%). Presence of residual shunt was evaluated 6 to 12 months by TEE and microembolic signals (MES) and was found in 17,6% vs 52,8% (84,4% of these were small), respectively (table 1). Presence of residual shunt was not related with anatomical risk features or dimension of PFO (intraprocedural balloon-sizing). During the follow-up (median time 2,17 years, IQR 4,92) there was a very low rate of stroke recurrency (1,6%). None of the patients developed new-onset atrial fibrillation. There was no case of erosion caused by the device.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusion:</u></strong> Our center experience shows that a well implemented and throughout programme for PFO closure, with a multidisciplinary team, can be achieved in non-terciary centres, with the procedure deemed as safe and effective. MES study was more sensitive than TEE to detect residual shunt, but longer follow-up is needed to show if this is associated with a higher probability of stroke recurrency in the future.</span></span></p>
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