Reintervention for intraprosthetic residual shunt following patent foramen ovale

Abstract Introduction Residual right to left (RTL) shunt after percutaneous closure of Patent Foramen Ovale (PFO) is not uncommon and may be associated with cerebrovascular events recurrence. Available data on the particularities of RTL shunts are scarce. Objective To describe a single-center cases series of percutaneous reintervention for residual intraprosthetic RTL shunt. Methods We retrospectively reviewed every patient treated for percutaneous reintervention for intraprosthetic RTL from January 1st, 2018, to December 31st, 2021. Results A total of 14 patients were described as having an intraprosthetic RTL residual shunt after percutaneous PFO closure in our center during the period of interest. In our cohort, 71% of patients (10) were male, with a mean age of 43 years old. Indication for PFO closure was secondary prevention of a cerebrovascular event stroke with 13 patients (93%). Characteristics of prior and second PFO intervention are presented in Table 1. Large devices were implanted during the first intervention, with a median left disc’s diameter of 25 21,5 - 25 mm and right disc’s diameter of 35 30 - 35 mm, and the implantation of Amplatzer Occluder Cribiform occurred with 6 patients (50%) with a median discs’ diameter of 35 35 - 40 mm. All but one patient addressed for reintervention presented a residual RTL shunt at least moderate. Residual RTL shunts were mainly closed using AVP II devices (9 patients, 62%), with a median size of 12 11 - 18 mm. Five patients (36%) had an Amplatzer PFO Occluder implanted. Two patients had a third implanted device, one had another large AVP II device of 20 mm, and one had another Amplatzer Occluder Cribiform of 40 mm. Conclusion To our knowledge, this study is the first recent cohort describing intra prosthetic RTL shunt following PFO closure. In our center, intra prosthetic shunt was a rare complication, who’s physiopathology remains unclear. However, it mainly occurs on complex anatomy with multi perforated atrial septum or associated with ASD or ASA. The use of AVP II is frequent for reintervention of residual intra prosthetic shunt, as well as the implantation of large devices.