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Closure of Atrial Septal Defect and Patent Foramen Ovale

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Percutaneous Treatment of Cardiovascular Diseases in Women

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Abstract

Secundum atrial septal defects cause, through a left-to-right shunt, an increase in the pulmonary blood flow and the size of the right heart chambers. These defects are amenable to catheter closure using a variety of devices, which have shown excellent results related to their safety and efficacy. In the older patients, additional co-morbidities may result in left ventricular diastolic dysfunction, and pulmonary hypertension can occur. The defects should be closed in the majority of patients after clinical and haemodynamic assessment, because of possible evolution of heart failure and/or pulmonary hypertension. In the older patients, there is an improvement in the symptoms and quality of life, even when the defect is closed above 60 years of age. Patients with pulmonary hypertension need to be carefully evaluated with pulmonary vasodilator drugs in order to decide on the appropriateness of catheter closure.

Patent foramen ovale (PFO) may be found in up to 25 % in the normal adult population. However, it is thought that patent foramen ovale may contribute to cryptogenic stroke and migraine. The presence of a large patent foramen ovale and an atrial septal aneurysm may predispose to a higher occurrence of strokes. Randomised studies have been performed in patients with PFO and cryptogenic strokes on closure versus medical treatment and showed no benefit in the prevention of stroke recurrence. However, 5-year follow-up results of the most important of these studies (RESPECT trial) showed a relative risk reduction of recurrent cryptogenic strokes by more than half after PFO closure.

Although closure of the foramen ovale has been advocated for patients with migraine, there are no clear data supporting these recommendations.

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Authors and Affiliations

  1. Department of Paediatric Cardiology, Evelina London Children’s Hospital, Westminster Bridge Road, London, UK

    Shakeel Ahmed Qureshi

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  1. Shakeel Ahmed Qureshi
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Correspondence to Shakeel Ahmed Qureshi .

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Editors and Affiliations

  1. Interventional Cardiology, Humanitas Research Hospital, Rozzano , Milano, Italy

    Patrizia Presbitero

  2. Interventional Cardiology, Klinik der Universität München Interventional Cardiology, München, Bayern, Germany

    Julinda Mehilli

  3. Hemodynamic Laboratory, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

    Anna Sonia Petronio

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Qureshi, S.A. (2017). Closure of Atrial Septal Defect and Patent Foramen Ovale. In: Presbitero, P., Mehilli, J., Petronio, A. (eds) Percutaneous Treatment of Cardiovascular Diseases in Women. Springer, Cham. https://doi.org/10.1007/978-3-319-39611-8_13

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  • DOI: https://doi.org/10.1007/978-3-319-39611-8_13

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