Second transcatheter closure for residual shunt following percutaneous closure of patent foramen ovale.

AIMS Residual shunt following percutaneous patent foramen ovale (PFO) closure has been described in up to 49% of patients and is associated with recurrent cerebrovascular events. Our aim was to evaluate the safety, feasibility, and midterm outcomes of transcatheter residual shunt closure. METHODS AND RESULTS From 1994 to July 2016, 2,679 patients underwent transcatheter PFO closure for treatment of presumed paradoxical embolism at our institution. Among them, 100 patients (3.7%) were referred for residual shunt closure. They constituted the study population for which a retrospective analysis of the prospectively gathered procedural data was performed along with prospective acquisition of follow-up data. The indication for initial PFO closure was an ischaemic cerebrovascular event in 85% of the patients. Patients underwent transoesophageal echocardiography (TOE) for PFO diagnosis and again for residual shunt assessment at about six months. All procedures were performed under fluoroscopic guidance only. At the first procedure, 10 different devices had been used. The AMPLATZER PFO Occluder accounted for 54% and the AMPLATZER Cribriform Occluder for 28%. Compared to the whole population (n=2,679), a significantly higher rate of atrial septal aneurysm (58% versus 36%; p=0.024), a larger proportion of shunt grade 3 at baseline (97% versus 78%; p<0.001), and a larger size (≥30 mm) of the first implanted device (47% versus 13%; p