Percutaneous closure of patent foramen ovale and valvular function -- effect of the amplatzer occluder.

BACKGROUND: Percutaneous closure of the patent foramen ovale (PFO) is a widely used procedure in patients with paradoxical embolism. Whether or not implantation of a PFO closure device alters cardiac chamber anatomy and in turn affects valvular function is unclear.

METHODS: Out of 334 patients who underwent PFO closure between 2002 and 2010, a total of 196 received an Amplatzer septal occluder and were retrospectively analyzed. Nineteen patients (9.7%) were excluded due to an incomplete follow-up. Thus, 177 patients with a mean age of 51 ± 13 years remained for analysis. Clinical and echocardiographic examinations were performed before and 6 month after PFO closure.

RESULTS: At follow-up, significant residual shunt (>20 microbubbles) was present in only 11 patients (6.2%). Newly developed or worsened aortic regurgitation (AR) was noted in 16 patients (9%), whereas in 2 patients (1%) a previously documented AR had disappeared. In 33 patients (19%), mitral valve regurgitation (MR) developed or worsened, while in 10 patients (5.6%) a previously documented MR was no longer present at follow-up. In 44 patients (25%), tricuspid regurgitation (TR) had developed at follow-up, while in 5 patients (3%) a previously documented TR was no longer visible echocardiographically.

CONCLUSION: Implantation of an Amplatzer septal occluder is a safe and effective procedure. However, it can induce or worsen valvular regurgitation in almost half of the patients. Although the degree of regurgitation was generally mild, it is likely that implanted devices alter cardiac chamber structure.