Percutaneous Closure of Patent Foramen Ovale with the Amplatzer PFO Occluder.

The foramen ovale, which remains probe-patent throughout adulthood in approximately one-fourth of the general population (1), has increasingly been recognized as potential mediator of several disease manifestations, including paradoxical embolism, refractory hypoxemia as a result of right-to-left shunt in patients with right ventricular infarction or severe pulmonary disease, orthostatic desaturation in the setting of the rare platypnea-orthodeoxia syndrome, neurological decompression illness in divers, and, more recently, migraine with aura. Percutaneous closure of the patent foramen ovale (PFO) has been shown safe and feasible using a variety of transseptal occlusion devices in previous reports (2- 10). Initial device-related complications inflicted by large delivery systems, device dislodgment and embolization, structural failure, thrombus formation, and inability to reposition or remove the device have been reduced by recent improvements in device design. In particular, the appreciation of anatomic and physiologic differences between PFOs and atrial-septal defects (ASDs), led to the development of devices specifically designed for percutaneous PFO closure. The Amplatzer PFO Occluder® (AGA Medical, Golden Valley, MN, USA) is a self-expanding device manufactured from nitinol wire with polyester fabric, which is fully removable and repositionable as long as it remains screwed to the delivery cable (11,12). In particular, the differences in design in contrast to the Amplatzer ASD Occluder are a smaller left than right atrial disk (except for the smallest model) and a slightly elongated, thin, and flexible waist connecting the two retention disks. In this chapter, the anatomy of the PFO, the currently available diagnostic techniques, the rationale for PFO closure, and the technique and the results of PFO closure using the Amplatzer PFO Occluder will be reviewed. [ABSTRACT FROM AUTHOR]