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A Journal on Heart and Vascular Diseases

Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2009 June;57(3):275-84


language: English

Anatomical patterns of patent foramen ovale (PFO): do they matter for percutaneous closure?

Presbitero P. 1, Lanzone A. M. 2, Albiero R. 2, Lisignoli V. 1, Zavalloni Parenti D. 1, Gasparini G. L. 1, Lodigiani C. 1, Barbaro C. 1, Fappani A. 2, Barberis G. 3, Rossi M. L. 1, Pagnotta P. 1

1 Department of Invasive Cardiology Humanitas Mirasole Clinic, Rozzano, Milan, Italy 2 Department of Cardiology San Rocco Di Franciacorta Private Clinic, Ome Brescia, Italy 3 Department of Invasive Cardiology Cellini Clinic, Turin, Italy


Aim. The aim of this study was to describe and classify the various anatomical pattern of patent foramen ovale (PFO) with transesophageal echocardiography (TEE) and to relate such classification to the selection of PFO closure devices.
Methods. This study enrolled 216 PFO patients (118 females) mostly with previous cryptogenic stroke or transitory ischemic attack (TIA) who underwent percutaneous closure of PFO with deep sedation under TEE control. Anatomical patterns were classified as follows: simple: PFO characterised by central/superior eccentric shunt or with a valve mechanism (45%); reduse: widely redundant septum primum (22%); ASA: atrial septal aneurysm (11%); EASA: entire atrial septal aneurysm (1.4%); CRIB: cribriform septum primum (9%); tunnel: tunnel between septum primum and secundum >10 mm (11%). Degree of right-to-left shunt, either at basal condition or at Valsalva manoeuvre, was classified as: 1=mild (45%); 2=moderate (42%); 3=severe (13%). Additional right-atrium anatomical features are also described.
Results. Procedure was successful in 100% of the cases. At follow-up recurrent TIA occurred in two patients. Residual shunts were present in 4.9% of the patients after Valsalva manoeuvre. Palpitations were reported in 4%.
Conclusion. Closing the PFO choosing the device following strict anatomical criteria based on TEE assessment allowed excellent immediate and late results minimizing residual shunts.

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