The Emerging Role of Intracardiac Echocardiography -- Into the ICE Age

Andrew R.J. Mitchell; Prasanna Puwanarajah; Jonathan Timperley; Harald Becher; Neil Wilson; Oliver J. Ormerod

Disclosures

Br J Cardiol. 2007;14(1):31-36. 

In This Article

Closure of Patent Foramen Ovale

A patent foramen ovale (PFO) is an oblique slit-like tunnel formed through lack of fusion of the atrial septum primum and septum secundum and can occur with other abnormalities of the atrial septum including atrial septal aneurysms.[5] Autopsy studies indicate that a PFO is present in approximately one quarter of the population with significant heterogeneity in the width and size of the defect. There has been considerable interest in the role of a PFO in young patients with stroke or migraine and subsequently an explosion in the use of devices to close PFOs by keen interventional cardiologists. In approximately 40% of patients with ischaemic stroke the cause remains unknown but, in younger patients (less than 55 years), the prevalence of PFO is high (50%).[6] Randomised comparisons of medical therapy (with anti-thrombotic therapy) versus percutaneous PFO closure are underway. Similarly, retrospective studies have suggested that percutaneous closure of PFOs in migraine sufferers with cryptogenic stroke relieves migraine symptoms in over 50% of patients.[7] A large prospective randomised study (http://www. migraine-mist.org) has now confirmed that PFO closure may reduce headache burden in some patients with migraine.

Devices to close PFOs are becoming simpler and quicker to use and the complication rate from these procedures is falling. The numbers of referrals for closure are already increasing and if the results of studies support PFO closure, then ICE seems perfectly poised for a local anaesthetic approach. Total catheter laboratory procedure and turnaround times are usually less than 30 minutes and the low procedural risk allows PFO closure to be performed as a day case.

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