Page 14 - Delaware Medical Journal - August, 2016

Successful Percutaneous Transcatheter Patent Foramen Ovale Closure through the Right Internal Jugular Vein Using Stiff Amplatzer Catheter with a Reshaped Tip Zaher Fanari, MD; Sumaya Hammami, MD, MPH; James T. Hopkins, MD
IntroductionPatent foramen ovale (PFO) is often
suspected as a cause of paradoxical embolism in patients who present with thromboembolism, especially in those with concomitant deep venous thrombosis.1 Transcatheter closure of PFO is indicated in patients with platypnea orthodeoxia syndrome (POS) and recurrent paradoxical embolism.2 Platypnea orthodeoxia is an uncommon syndrome of dyspnea and hypoxemia induced by upright posture which is subsequently relieved by recumbency. Traditionally, this condition has been reported in association with pulmonary, hepatic, and cardiac diseases, but the mechanism is different in each situation. In presence of an atrial septal defect, a right to left cardiac shunt resulting as a consequence of redirection of the postural hypoxemia.
Closure of PFO is usually performed through a femoral vein approach.2,3 The anatomy of the inferior vena cava and of the interatrial septum makes the femoral approach the easiest way to cross PFO and deploy an occluder device PFO.4
When the femoral access is not feasible because of congenital or acquired inferior vena cava interruption, transcatheter closure of PFO is challenging and only a few successful procedures were reported.4-6 We describe the successful closure of a PFO using the right internal jugular venous approach and a catheter delivery system
FIGURE 1
Transesophageal Echocardiography Showing Atrial Septum Aneurysm With Patent Foramen Ovale. (Abbreviations:
LA: Left Atrium; RA: Right Atrium; ASA: Atrial Septum Aneurysm; PFO: Patent Foramen Ovale)
FIGURE 4
No Residual Flow On Transesophageal Echocardiography After Successful Deployment Of
ASD Occluder. (Abbreviations: LA: Left Atrium; RA: Right Atrium; ASD occluder: Atrial Septal Defect occluder)
Percutaneous transcatheter closure of a patent foramen ovale (PFO) remains challenging when the femoral venous approach is not available. We describe the successful closure of a PFO using the right internal jugular venous approach and a catheter delivery system with a reshaped tip in a patient with a PFO, recurrent stroke, recurrent gastrointestinal bleeding, bilateral deep venous thrombosis and thrombosed bilateral inferior vena cava filter.
Key Words: Percutaneous Transcatheter Closure, Patent Foramen Ovale, Stroke, DVT, Right Internal Jugular Vein
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Del Med J
| August 2016 | Vol. 88 | No. 8
Abstract