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OP-356 PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE WITH VARIOUS OCCLUDER DEVICES IN PATIENTS WITH CRYPTOGENIC STROKE
Oral Presentations / International Journal of Cardiology 155S1 (2012) S1–S89
closure, longitudinal deformation parameters of RA and RV were normalized to the control group. OP-355 CLINICAL AND CRANIAL MAGNETIC RESONANCE IMAGING FOLLOW-UP AFTER PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE IN PATIENTS WITH CRYPTOGENIC STROKE A.H. Ates1 , A. Oto2 , K. Aytemir2 , U. Canpolat2 , H. Yorgun3 , 2 2 ¨ H. Sunman2 , A. Ulgen , M.U. Yalcin ¸ 2 , L. Sahiner ¸ , E.B. Kaya2 , L. Tokgozoglu2 , G. Kabakci ¸ 2 . 1 Ataturk State Hospital, Sinop, Turkey; 2 Department of Cardiology, Hacettepe University, Ankara, Turkey; 3 Develi State Hospital, Kayseri, Turkey Objective: Patent foramen ovale (PFO) closure is reported to result in fewer episodes of clinically manifest recurrent cerebral ischemia than medical treatment. We evaluated by means of magnetic resonance imaging (MRI) whether silent cerebral ischemic episodes are also decreased by PFO closure. Methods: Fourty-seven patients (22 male, 38.4±8.6 years) with PFO were selected for percutaneous closure of PFO at our center. All had PFO with large right-to-left shunt documented by transcranial Doppler ultrasound and transesophageal echocardiography, >1 previous stroke or transient ischemic attack with MRI documentation at the index event, and no alternative cause for cerebral ischemia. MRI studies were performed in all patients 24 hours before the procedure and at 1-year follow-up (or before in the case of a suspected new neurologic event). Also 24 h Holter monitorization was performed to all patients at baseline and follow-up visits. Results: Comparing the baseline and follow-up MRI studies, no new-onset clinical or silent ischemic lesions were observed. After PFO closure (follow-up 24.3±10.5 months), no recurrent neurologic event (stroke or transient ischemic attack) occurred. Also, during follow-up, atrial fibrillation was not detected in any patients. We detected mobitz type 1 AV block in one patient, frequent supraventricular premature contractions in 2 patients, ≥grade 2 ventricular premature contractions in 2 patients. Conclusions: Transcatheter PFO closure results in no clinical or silent neurological events and arrhytmias after 1-year follow-up, especially when complete PFO closure is successfully performed. OP-356 PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE WITH VARIOUS OCCLUDER DEVICES IN PATIENTS WITH CRYPTOGENIC STROKE 2 ¨ , E.B. Kaya1 , U. Canpolat1 , A. Oto1 , K. Aytemir1 , S. Ozkutlu 1 H. Yorgun3 , A.H. Ates4 , M. Dural1 , H. Sunman1 , L. Sahiner ¸ , 1 1 1 L. Tokgozoglu , G. Kabakci ¸ . Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Cardiology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey; 3 Develi State Hospital, Kayseri, Turkey; 4 Ataturk State Hospital, Sinop, Turkey Objective: Percutaneous patent foramen ovale (PFO) closure has been shown safe and feasible using a variety of devices. The aim of our study is to evaluate the effectiveness and safety of the occluder devices for transcatheter closure of PFO. Methods: We enrolled 171 patients (87 males; mean age 40.5±10.3 years) in whom transcatheter PFO closure was performed between May 2004 and November 2011. The patients were less than 55 years old with at least two episodes of transient ischemic attack (TIA) or stroke, or with multiple ischemic gliotic lesions showed by cranial MRI. All other causes of TIA or stroke were excluded, and the patients were shown to have PFO by transesophageal echocardiography. Patients were evaluated clinically and echocardiographically at 1, 6 and 12 months after the procedure and yearly thereafter. Primary endpoints were death, recurrent stroke or TIA. Mean follow-up perios was 26.8±17.5 months.
S85
Results: During the study period, 74 (43.3%) Amplatzer, 76 (44.4%) Occlutech Figulla and 21 (12.3%) BioSTAR PFO occluder devices were used. The mean device diameter was 24.4±2.69 (18–28) mm. All interventions were successfully completed without any complications. There was no recurrent stroke or TIA in the study group during long-term follow-up period. Only one patient had bilateral renal embolic event (0.5%). Also 1 (0.5%) patient revealed late thrombus formation on PFO occluder device after total abdominal histerectomy operation. Conclusions: Transcatheter closure of PFOs by PFO occluder devices may be feasible, safe, and effective treatment for the prevention of CVA recurrence in patients with crytogenic stroke. OP-357 PERCUTANEOUS CLOSURE OF SECUNDUM ATRIAL SEPTAL DEFECTS USING VARIOUS OCCLUDER DEVICES: LONG TERM FOLLOW-UP RESULTS 2 ¨ , E.B. Kaya1 , U. Canpolat1 , A. Oto1 , K. Aytemir1 , S. Ozkutlu 1 H. Yorgun3 , A.H. Ates4 , K.M. Gurses1 , H. Sunman1 , L. Sahiner ¸ , 1 1 1 L. Tokgozoglu , G. Kabakci ¸ . Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Cardiology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey; 3 Develi State Hospital, Kayseri, Turkey; 4 Ataturk State Hospital, Sinop, Turkey Objective: The incidence of transcatheter closure of secundum atrial septal defects (ASD) which has become an established treatment option, is constantly increasing. The aim of our study is to evaluate the effectiveness and safety of the Amplatzer and Figulla Septal Occluder devices for secundum ASD closure. Methods: Study cohort constitutes 163 patients (66 males; mean age 37.5±13.9 years) who underwent percutaneous ASD closure with Amplatzer (n = 105) and Figulla (n = 58) Occluder devices between January 2001 and November 2011. Before the procedure, all patients had undergone transthoracic or transesophageal echocardiography (TEE) and electrocardiography. Ostium secundum ASDs with enough rim length for device attachment were considered to be suitable for transcatheter occlusion. All procedures were conducted in the hemodynamic laboratory under general anesthesia with the guidance of TEE. Follow-up visits were scheduled 1, 3, 6, and 12 months after the procedure and annually thereafter. Results: The mean device size was 19.8±6.1 mm (range 7–36 mm). All interventions were successfully completed without complications except device embolization from left atrium to the abdominal aorta which extracted by femoral snare system, and thereafter ASD was closed with a larger device in 1 patient (0.6%) and also periprocedural thrombus formation who successfully treated with unfractioned heparin in 2 patients. In one case (n = 0.6%), two septal occluder device were used for 2 separate ASDs. During the mean 33.5±25.0 (6–131) months follow-up period, no patient had a major complication (cardiac rupture, thromboembolism, thrombus, device embolism or infective endocarditis). Only in one case (0.6%) paroxismal atrial fibrillation was developed and converted to sinus rhythm with medical cardioversion. Conclusions: Transcatheter closure of secundum ASDs by Amplatzer and Figulla Septal Occluder may be feasible, safe, and effective alternative to surgery whenever the size and the location of ASD is suitable.
closure, longitudinal deformation parameters of RA and RV were normalized to the control group. OP-355 CLINICAL AND CRANIAL MAGNETIC RESONANCE IMAGING FOLLOW-UP AFTER PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE IN PATIENTS WITH CRYPTOGENIC STROKE A.H. Ates1 , A. Oto2 , K. Aytemir2 , U. Canpolat2 , H. Yorgun3 , 2 2 ¨ H. Sunman2 , A. Ulgen , M.U. Yalcin ¸ 2 , L. Sahiner ¸ , E.B. Kaya2 , L. Tokgozoglu2 , G. Kabakci ¸ 2 . 1 Ataturk State Hospital, Sinop, Turkey; 2 Department of Cardiology, Hacettepe University, Ankara, Turkey; 3 Develi State Hospital, Kayseri, Turkey Objective: Patent foramen ovale (PFO) closure is reported to result in fewer episodes of clinically manifest recurrent cerebral ischemia than medical treatment. We evaluated by means of magnetic resonance imaging (MRI) whether silent cerebral ischemic episodes are also decreased by PFO closure. Methods: Fourty-seven patients (22 male, 38.4±8.6 years) with PFO were selected for percutaneous closure of PFO at our center. All had PFO with large right-to-left shunt documented by transcranial Doppler ultrasound and transesophageal echocardiography, >1 previous stroke or transient ischemic attack with MRI documentation at the index event, and no alternative cause for cerebral ischemia. MRI studies were performed in all patients 24 hours before the procedure and at 1-year follow-up (or before in the case of a suspected new neurologic event). Also 24 h Holter monitorization was performed to all patients at baseline and follow-up visits. Results: Comparing the baseline and follow-up MRI studies, no new-onset clinical or silent ischemic lesions were observed. After PFO closure (follow-up 24.3±10.5 months), no recurrent neurologic event (stroke or transient ischemic attack) occurred. Also, during follow-up, atrial fibrillation was not detected in any patients. We detected mobitz type 1 AV block in one patient, frequent supraventricular premature contractions in 2 patients, ≥grade 2 ventricular premature contractions in 2 patients. Conclusions: Transcatheter PFO closure results in no clinical or silent neurological events and arrhytmias after 1-year follow-up, especially when complete PFO closure is successfully performed. OP-356 PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE WITH VARIOUS OCCLUDER DEVICES IN PATIENTS WITH CRYPTOGENIC STROKE 2 ¨ , E.B. Kaya1 , U. Canpolat1 , A. Oto1 , K. Aytemir1 , S. Ozkutlu 1 H. Yorgun3 , A.H. Ates4 , M. Dural1 , H. Sunman1 , L. Sahiner ¸ , 1 1 1 L. Tokgozoglu , G. Kabakci ¸ . Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Cardiology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey; 3 Develi State Hospital, Kayseri, Turkey; 4 Ataturk State Hospital, Sinop, Turkey Objective: Percutaneous patent foramen ovale (PFO) closure has been shown safe and feasible using a variety of devices. The aim of our study is to evaluate the effectiveness and safety of the occluder devices for transcatheter closure of PFO. Methods: We enrolled 171 patients (87 males; mean age 40.5±10.3 years) in whom transcatheter PFO closure was performed between May 2004 and November 2011. The patients were less than 55 years old with at least two episodes of transient ischemic attack (TIA) or stroke, or with multiple ischemic gliotic lesions showed by cranial MRI. All other causes of TIA or stroke were excluded, and the patients were shown to have PFO by transesophageal echocardiography. Patients were evaluated clinically and echocardiographically at 1, 6 and 12 months after the procedure and yearly thereafter. Primary endpoints were death, recurrent stroke or TIA. Mean follow-up perios was 26.8±17.5 months.
S85
Results: During the study period, 74 (43.3%) Amplatzer, 76 (44.4%) Occlutech Figulla and 21 (12.3%) BioSTAR PFO occluder devices were used. The mean device diameter was 24.4±2.69 (18–28) mm. All interventions were successfully completed without any complications. There was no recurrent stroke or TIA in the study group during long-term follow-up period. Only one patient had bilateral renal embolic event (0.5%). Also 1 (0.5%) patient revealed late thrombus formation on PFO occluder device after total abdominal histerectomy operation. Conclusions: Transcatheter closure of PFOs by PFO occluder devices may be feasible, safe, and effective treatment for the prevention of CVA recurrence in patients with crytogenic stroke. OP-357 PERCUTANEOUS CLOSURE OF SECUNDUM ATRIAL SEPTAL DEFECTS USING VARIOUS OCCLUDER DEVICES: LONG TERM FOLLOW-UP RESULTS 2 ¨ , E.B. Kaya1 , U. Canpolat1 , A. Oto1 , K. Aytemir1 , S. Ozkutlu 1 H. Yorgun3 , A.H. Ates4 , K.M. Gurses1 , H. Sunman1 , L. Sahiner ¸ , 1 1 1 L. Tokgozoglu , G. Kabakci ¸ . Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Cardiology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey; 3 Develi State Hospital, Kayseri, Turkey; 4 Ataturk State Hospital, Sinop, Turkey Objective: The incidence of transcatheter closure of secundum atrial septal defects (ASD) which has become an established treatment option, is constantly increasing. The aim of our study is to evaluate the effectiveness and safety of the Amplatzer and Figulla Septal Occluder devices for secundum ASD closure. Methods: Study cohort constitutes 163 patients (66 males; mean age 37.5±13.9 years) who underwent percutaneous ASD closure with Amplatzer (n = 105) and Figulla (n = 58) Occluder devices between January 2001 and November 2011. Before the procedure, all patients had undergone transthoracic or transesophageal echocardiography (TEE) and electrocardiography. Ostium secundum ASDs with enough rim length for device attachment were considered to be suitable for transcatheter occlusion. All procedures were conducted in the hemodynamic laboratory under general anesthesia with the guidance of TEE. Follow-up visits were scheduled 1, 3, 6, and 12 months after the procedure and annually thereafter. Results: The mean device size was 19.8±6.1 mm (range 7–36 mm). All interventions were successfully completed without complications except device embolization from left atrium to the abdominal aorta which extracted by femoral snare system, and thereafter ASD was closed with a larger device in 1 patient (0.6%) and also periprocedural thrombus formation who successfully treated with unfractioned heparin in 2 patients. In one case (n = 0.6%), two septal occluder device were used for 2 separate ASDs. During the mean 33.5±25.0 (6–131) months follow-up period, no patient had a major complication (cardiac rupture, thromboembolism, thrombus, device embolism or infective endocarditis). Only in one case (0.6%) paroxismal atrial fibrillation was developed and converted to sinus rhythm with medical cardioversion. Conclusions: Transcatheter closure of secundum ASDs by Amplatzer and Figulla Septal Occluder may be feasible, safe, and effective alternative to surgery whenever the size and the location of ASD is suitable.