Percutaneous closure of interatrial communications in adults – prospective embolism prevention study with two- and three-dimensional echocardiography

We included 161 patients (mean age 46.8 ± 11 years, 83 females) with patent foramen ovale or atrial septal defect and at least one documented paradoxical systemic thrombembolic event and/or a large atrial shunting.The implantation procedure was successfully performed without major complications in all patients and minor complications in 2.5%. Two and / or three dimensional echocardiography was performed before and after 4 weeks and 12 months using a multiplane transoesophageal probe. After 4 weeks and 6 months two patients had minimal shunting. These residual defects were closed with a second device implantation without shunting after further 4 weeks. During a follow-up of 324.3 patient years (range, 13 to 19 months), recurrent embolic events occurred in only 1 patient (0.6%).After primary paradoxical systemic embolism, results of transcatheter occlusion of the interatrial communications are dependent on the closure device system and can prevent further secondary embolic events for up to 1 year after the percutaneous closure. Three dimensional echocardiography provides dynamic features of the defects and the post closure status and may lead to an improved understanding and diagnosis of the interatrial defect.Atrial septal defect (ASD) and patent foramen ovale (PFO) are the most common cardiac abnormalities. They predispose to cerebral ischemia as a result of paradoxical thromboembolism by right-to-left shunting under conditions or physiologic maneuvers that raise right atrial pressure [1,2]. Several studies using contrast echocardiography established a strong association between cryptogenic stroke and the presence of PFO in young adults < 55 years old [1,3,4]. Stroke databases suggest that despite intensive evaluation, approximately 40% of all patients suffering ischemic strokes without a clearly identifiable cause [5]. The term "presumed paradoxical embolism" is used for patients after exclusion of all known causes of arterial thrombosis and thrombembolism (atheros