Page 17 - Delaware Medical Journal - August, 2016
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CASE REPORT
analyses, with a low rate of associated risks.9,10 A meta-analysis of observational studies suggests that PFO closure was superior to medical treatment alone.3
The femoral approach for transcatheter closure of PFO has a high rate of success. Fetal circulation, in which oxygenated blood
the foramen ovale by the Eustachian valve, also provides the appropriate angle for a guide wire to cross into the left atrium. The angle between IVC and PFO tunnel is usually around 45 degrees and therefore the device delivery system inserted along the guidewire can reach the left atrium allowing deployment of 4
of it contraindicated femoral approach. The two approaches left were trans-hepatic and right internal jugular approaches. Both are more challenging than the femoral approach. A trans-hepatic approach allows access to the PFO through the IVC and therefore 6 However, this approach requires gelfoam or coils to achieve hemostasis in the trans-hepatic tract and puts patient at risk of peritoneal bleeding.11 Our patient had extensive bleeding requiring hemi-colectomy and putting him at risk for another laparotomy should be avoided if possible.
A right internal jugular approach was used successfully in two
REFERENCES
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2. Martin F, Sanchez PL, Doherty E, et al. Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism. Circ J Am Heart Assoc. 2002;106:1121-1126.
3. Kitsios GD, Dahabreh IJ, Abu Dabrh AM, Thaler DE, Kent DM. Patent foramen ovale closure and medical treatments for secondary stroke prevention: a systematic review of observational and randomized evidence. Stroke J Cereb Circ. 2012;43:422-431.
4. Hascoet S, Fraisse A, Elbaz M. Successful percutaneous transcatheter patent foramen ovale closure through the right internal jugular vein using a steerable catheter. Cathet Cardiovas Intervent. 2013;82:E598-602.
5. Sader MA, De Moor M, Pomerantsev E, Palacios IF. Percutaneous transcatheter patent foramen ovale closure using the right internal jugular venous approach. Cathet Cardiovas Intervent. 2003;60:536-539.
6. Hussain J, Strumpf R, Ghandforoush A, Jamal A, Diethrich E. Transhepatic approach to closure of patent foramen ovale: report of 2 cases in adults. Texas Heart Inst J. 2010;37:553-556.
5 The second 4 To achieve the sharp angle needed, a catheter with a sharp angle Torque-view sheath.
CONCLUSION
transcatheter PFO closure through the right internal jugular vein using an Amplatzer delivery sheath with a reshaped tip. A trans- jugular approach might be a feasible alternative for PFO closure when trans-femoral and trans-hepatic approaches are not possible or carry an increased risk.
CONTRIBUTING AUTHORS
■ ZAHER FANARI, MD is an Interventional Cardiovascular Fellow at the University of Kansas Medical Center. He was a Cardiovascular Medicine Fellow at Christiana Care Health System at the time this article was written.
■ SUMAYA HAMMAMI, MD, MPH is associated with the Department of Cardiology at Christiana Care Health System in Newark, Del.
■ JAMES T. HOPKINS, MD is a Cardiologist practicing with Christiana Care Cardiology Consultants in Newark, Del.
7. Mas JL, Zuber M. Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack. French Study Group on Patent Foramen Ovale and Atrial Septal Aneurysm. Am Heart J. 1995;130:1083- 1088.
8. Kent DM, Ruthazer R, Weimar C, et al. An index to identify stroke- related vs incidental patent foramen ovale in cryptogenic stroke. Neurol. 2013;81:619-625.
9. Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med. 2012;366:991-999.
10. Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med. 2013;368:1092-1100.
11. McLeod KA, Houston AB, Richens T, Wilson N. Transhepatic approach for cardiac catheterisation in children: initial experience. Heart. 1999;82:694-696.
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