Author + information
- Received April 1, 2020
- Revision received May 27, 2020
- Accepted June 2, 2020
- Published online September 21, 2020.
- Achille Gaspardone, MD, MPhila,∗ (, )@a_gaspardone,
- Gregory A. Sgueglia, MD, PhDa,
- Antonella De Santis, MDa,
- Emanuela D’Ascoli, MDa,
- Maria Iamele, MDa,
- Fabiana Piccioni, MDa,
- Benedetta Giannico, MDa,
- Fabrizio D’Errico, MDa,
- Gaetano Gioffrè, MDa,
- Francesco Summaria, MDa,
- Carlo Gaspardone, MDa and
- Francesco Versaci, MDb
- aDivision of Cardiology, Sant’Eugenio Hospital, Rome, Italy
- bDivision of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
- ↵∗Address for correspondence:
Dr. Achille Gaspardone, U.O.C. di Cardiologia, Ospedale Sant’Eugenio, Piazzale dell’Umanesimo 10, 00144 Rome, Italy.
Objectives This study sought to assess patent fossa ovalis (PFO) anatomy by transesophageal echocardiography (TEE) in patients undergoing percutaneous suture-mediated PFO closure to identify predictors of post-procedural residual atrial right-to-left shunt (RLS).
Background Percutaneous suture-mediated PFO closure has been proven to be a safe and effective technique in most PFO patients.
Methods From June 2016 to October 2019, 247 consecutive patients underwent percutaneous suture-mediated PFO closure at our institution. Of them, 230 (46 ± 13 years of age, 146 women) had complete and technically evaluable pre-procedural TEE. The following parameters in short-axis view were assessed: presence and grade of spontaneous RLS, PFO length and width, presence of atrial septal aneurysm and its maximal bulge, and presence of an embryonic or fetal remnant (Chiari network or Eustachian valve).
Results At the first follow-up transthoracic echocardiography performed between 3 and 6 months from the closure procedure, a residual RLS ≥2 grade was found in 37 (16%) patients. Grade of pre-procedural spontaneous RLS (hazard ratio: 1.99; 95% confidence interval: 1.14 to 3.48; p = 0.016) shunt and PFO width (hazard ratio: 2.52; 95% confidence interval: 1.85 to 3.43; p < 0.001) were both found to be significantly associated with significant residual RLS at multivariable analysis. The presence of atrial septal aneurysm and its maximal bulge and of congenital remnants was not associated with significant residual RLS.
Conclusions Percutaneous suture-mediated PFO closure is feasible in the majority of septal anatomies; however, PFO >5 mm in width and spontaneous large RLS are less likely to be closed with 1 stitch only.
Dr. Gaspardone has served as a proctor of HeartStitch, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received April 1, 2020.
- Revision received May 27, 2020.
- Accepted June 2, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.