Complications
Patients who suffer from an acute illness resulting in temporary elevation of right heart pressures (e.g., acute PE, pneumonia, and mechanical ventilation) may experience right-to-left shunting of blood across the PFO, resulting in persistent hypoxemia.
Patients on mechanical ventilation may have difficulty weaning from oxygen supply as they often remain hypoxemic.
Incomplete closure may be treated with observation.
Published reports show use of an additional device to close residual defects.[42]
An extremely rare complication of device deployment that requires surgical intervention.
An extremely rare complication of device deployment that requires surgical intervention.
PFO closure with antiplatelet therapy increases the absolute risk of persistent atrial fibrillation or flutter by 1.8% and transient atrial fibrillation or flutter by 1.2% at 1 year.[25]
An extremely rare complication of device deployment.
An extremely rare complication of device deployment.[44]
Evidence suggests migraines are more frequent in patients with PFO and anecdotal evidence suggests improvement in headache symptoms after closure.[2][14]
In a patient with frequent, disabling migraines despite medications, closure of a PFO may be considered.
Although percutaneous closure is relatively safe, the evidence is not strong enough to recommend closure due to migraines.
Further evidence is likely to emerge with ongoing studies.
PFO closure in one UK study failed to achieve its primary end point of eliminating migraine headaches in 40% of subjects. However, significant reduction in migraine headache burden did occur.[41]
An extremely rare complication of device deployment.[44]
Paradoxical embolism occurs through a PFO.
An evaluation by the multidisciplinary team is recommended to determine management options for the patient, including PFO closure with medical therapy or medical therapy alone.
Certain prothrombotic mutations such as factor V Leiden (FV[G1691A] mutation) and the prothrombin mutation (PT[G20210A] mutation) have been suggested as increasing risk of cerebral ischemia in patients with PFO.[40]
Paradoxical embolism occurs through a PFO.
The majority of clinical trials for PFO closure did not include TIA in the inclusion criteria. Careful multidisciplinary evaluation is recommended to determine the management plan for the patients.[22][23] Initiation of antiplatelet or anticoagulation therapy is recommended, depending on the patient’s specific factors.
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