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A Journal on Heart and Vascular Diseases
Official Journal of the Italian Society of Angiology and Vascular Pathology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,752
Minerva Cardioangiologica 2009 June;57(3):285-9
Safety and long-term results of patent foramen ovale transcatheter closure in patients with thrombophilia
Rigatelli G. 1, Dell’Avvocata F. 1, Giordan M. 1, Camerotto A. 2, Panin S. 1, Ronco F. 1, Cardaioli P. 1
1 Section of Adult Congenital and Adult Heart Disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital, Rovigo, Italy
2 Laboratory Medicine Trecenta “San Luca” Hospital, Rovigo, Italy
Aim. Trials on transcatheter closure of patent foramen ovale (PFO) in different settings attempted to exclude patients with thrombophilia for the risk of device thrombosis. Authors sought to retrospectively evaluate safety and results of transcatheter PFO closure in patients with confirmed coagulation abnormalities.
Methods. Between December 2006 and Decem-ber 2008, 30 out of 98 consecutive patients (mean age 40±10.9 years, 23 females) referred to Rovigo General Hospital for transcatheter closure had coagulation abnormalities including mutations of factor V Leiden, factors X, VIII, protein C, S, MHFTR factors, and antiphospholipid and anticardiolipin antibodies, hyperhomocisteinimia. All patients underwent preoperative transesophageal echo and brain magnetic resonance imaging, and intra-cardiac echo-guided transcatheter PFO closure.
Results. Success rate was 100%; there was no difference in occlusion and complications rates between patients with and without thrombophilia: in particular no device thrombosis or recurrent cerebral ischemia or stroke were observed during the follow-up. Patients with thrombophilia had a higher incidence of atrial septal aneurysm, migraine with aura and deep venous thrombosis in the previous medical history compared to patients without.
Conclusion. Despite its small sample, this study suggests that patients with coagulation abnormalities should not be excluded from the trial; they have potentially a higher risk of stroke through a PFO compared to other patients, and transcatheter closure is as safe and effective as in general population with almost no additional therapy rather than aspirin.