Device closure of residual shunt after percutaneous closure of patent foramen ovale

AIMS: To summarise our experiences of device closure of residual shunt after transcatheter closure of patent foramen ovale (PFO). METHODS AND RESULTS: Since October 1997 implantation of a second closure device was attempted in 40 patients with a moderate or large residual shunt after implantation of a PFO closure device. The mean age of the patients was 51 years. Implantation of a second closure device was technically successful in 39/40 patients (98 %). The following devices were implanted: Premere (n=20), Amplatzer PFO (n=13), STARFlex (n=4), Helex (n=1), Angelwings (n=1). During a mean follow-up of 36+/-29 months complete closure was achieved in 27 patients (69 %). The remaining shunt was small in nine patients, moderate in one and large in two. One patient with a moderate and one patient with a large residual shunt received a third device. The third patient was sent to surgery. One patient died 21 days after implantation of a third closure device due to acute pericardial tamponade. No other complications occurred. CONCLUSIONS: Transcatheter implantation of a second closure device after PFO closure is feasible. Complete closure can be achieved in the majority of patients.