“PFO Closure: anatomical variants and implications for choice of procedure, success rates and complications” LM Shapiro. Papworth Hospital, Cambridge

NO CONFLICT OF INTEREST TO DECLARE

“PFO Closure: What are we trying to achieve LM Shapiro

“PFO Closure: What are we trying to achieve complete closure LM Shapiro

Basic anatomy

ASSESSMENT OF PFO Characterisation Tunnel length / height / width Flap separation / adhesion – RA/LA edge, body Flap retraction – spontaneous / potential Tunnel openings “PFD (patent foramen defect)”– ASD structurally merged with PFO or PFO with functional ASD

Incomplete PFO closure

Residual flow (AGA device)

Papworth Hospital 2005 to consecutive pfo closures (271 devices) No late complication

3 balloon morphologies. SHORTTUNNEL LONGTUNNEL ? SHORT TUNNEL ? LONG TUNNEL

Typical PFO – LA edge tunnel height and width flap separation with wire

Partial Split-level PFO. Apposition at RA edge only. fixed tunnel 1cm. LA edge tethered into LA

Narrow partial fixed split, long tunnel, narrow RA opening Shortest tunnel segment 12.5mm PosterosuperiorAnterosuperior

Spontaneous flap retraction

Papworth Hospital Conclusion No one device fits all defects Complete closure is necessary for stroke prevention Echo Pfo characteristics determine appropriate device

Papworth Hospital Conclusion No one device fits all defects Complete closure is necessary for stroke prevention Echo Pfo characteristics determine appropriate device

Typical PFO – tunnel height or flap separation

Typical PFO – LA edge tunnel width with wire

Long tunnel, partial fixed split, narrow flap separation

Septal bounce Flap retraction

Flap attachment Flap attachment point, marked by small indent of LA wall

Partial Split-level PFO. Apposition at RA edge only. fixed tunnel 1cm. LA edge tethered into LA, may not retract device traction to shorten tunnel much

5mm distance disk to disk including disk thickness Approx 3mm waist