Patent foramen ovale (PFO) closure device

Case contributed by Hilary Bowman

Presentation

History of PFO s/p PFO occluder device placement presenting for evaluation of new cardiomyopathy.

Patient Data

Age: 40 years
Gender: Male

Coronary Artery CT Angiography

ct

1.     No evidence of coronary stenosis or plaque by Coronary CT Angiography.

2.     Septal occluder is seen between the right atrium and left atrium, consistent with history of patent foramen ovale s/p device closure.

3.     No thickening or calcifications in the aortic and mitral valves.

4.     Mildly dilated left ventricle.

5.     Asymmetric thickening of the septal wall of the left ventricle.

Chest radiograph s/p AICD placement

x_ray

Interval placement of AICD.

1.     Dual lead left-sided AICD is now seen in place with appropriately positioned right atrial and right ventricular leads.

2.     A septal occluder is seen in appropriate position between the right and left atrium.

3.     Mild cardiomegaly without pulmonary vascular congestion considering technique.

4.     No discrete focal pneumonic consolidation, definite pleural effusion or pneumothorax.

5.     No acute osseous findings. Patient's hand projects over the upper abdomen.

Case Discussion

Patent foramen ovale (PFO) is relatively common, occurring in 25-30% of the population, and mostly asymptomatic. Percutaneous PFO closure can be recommended in patients under 60 years with embolic-appearing ischemic cryptogenic stroke and PFO with right-to-left shunt, with other etiologies of stroke excluded. 

A few devices have been used for PFO closure, including a STARflex device, Amplatzer PFO Occluder, and Gore Helex and Cardioform Septal Occluders. A nickel-titanium alloy (Nitinol) is frequently used in these devices and appears mildly radiopaque on radiograph and hyper-dense on CT.

Based on device appearance and year of implant, this patient most likely has a Gore Septal Occluder. It consists of a double disc shape made of a single piece of nitinol wire covered with e-polytetrafluoroethylene. It is inserted via a catheter and deployed across the septal defect, thus bridging the PFO.

Disclosure:  I, Hilary Bowman, have no actual or potential ethical or financial conflict of interest in relation to this device. This case is not intended to be a personal endorsement or recommendation of this product.

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center

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