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Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report

BACKGROUND: Percutaneous suture-mediated patent foramen ovale (PFO) closure has recently been used with the aim of avoiding double-disc nitinol device implantation. This novel technique has been carried out successfully in several centers offering PFO closure with an effective closure rate comparabl...

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Autores principales: Onorato, Eustaquio Maria, Grancini, Luca, Monizzi, Giovanni, Mastrangelo, Angelo, Fabbiocchi, Franco, Bartorelli, Antonio L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10097917/
https://www.ncbi.nlm.nih.gov/pubmed/37063961
http://dx.doi.org/10.3389/fcvm.2023.1095661
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author Onorato, Eustaquio Maria
Grancini, Luca
Monizzi, Giovanni
Mastrangelo, Angelo
Fabbiocchi, Franco
Bartorelli, Antonio L.
author_facet Onorato, Eustaquio Maria
Grancini, Luca
Monizzi, Giovanni
Mastrangelo, Angelo
Fabbiocchi, Franco
Bartorelli, Antonio L.
author_sort Onorato, Eustaquio Maria
collection PubMed
description BACKGROUND: Percutaneous suture-mediated patent foramen ovale (PFO) closure has recently been used with the aim of avoiding double-disc nitinol device implantation. This novel technique has been carried out successfully in several centers offering PFO closure with an effective closure rate comparable to conventional double-disc devices. CASE SUMMARY: A 50-year-old man, a pentathlon athlete, suffering from a previous left-sided ischemic stroke, underwent percutaneous closure of a permanent right-to-left shunt via PFO with a large fenestrated septum primum aneurysm at another institution. The NobleStitch® system was successfully implanted using local anesthesia and under angiographic-fluoroscopic monitoring. He was discharged home on aspirin 100 mg daily with a moderate residual shunt on contrast transthoracic echocardiography (cTTE) that persisted unaltered at subsequent controls. After 7 months, unable to resume sporting activity because of physical discomfort and dyspnea on exertion, the patient asked for a second opinion at our Heart and Brain clinic. Two-dimensional (2D) TTE showed septum primum laceration next to a radiopaque polypropylene knot with a moderate bidirectional shunt located at the fenestrated septum primum far from the PFO site. A catheter-based closure of the septal defect was therefore planned under local anesthesia and rotational intracardiac echo monitoring. An equally sized discs 28.5 mm × 28.5 mm Flex II UNI occluder (Occlutech GmbH, Jena, Germany) was successfully implanted across the atrial septal defect without complications. The patient was discharged in good clinical conditions; dual antiplatelet therapy (aspirin 100 mg/daily and clopidogrel 75 mg/daily) was recommended for 2 months and then single antiplatelet therapy (aspirin100 mg/daily) up to 6 months. Abolition of the residual shunt was confirmed at 1- and 6-month follow-up by contrast transcranial Doppler and 2D color Doppler cTTE. DISCUSSION: Closing a PFO with a suture-base system, without leaving a device implant behind, may be a cutting-edge technology and potential alternative to traditional devices. Nevertheless, meticulous selection of the PFO anatomies by 2D TEE is key to a successful closure procedure in order to avoid complications that must be managed again with a second percutaneous procedure or by surgery.
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spelling pubmed-100979172023-04-14 Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report Onorato, Eustaquio Maria Grancini, Luca Monizzi, Giovanni Mastrangelo, Angelo Fabbiocchi, Franco Bartorelli, Antonio L. Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Percutaneous suture-mediated patent foramen ovale (PFO) closure has recently been used with the aim of avoiding double-disc nitinol device implantation. This novel technique has been carried out successfully in several centers offering PFO closure with an effective closure rate comparable to conventional double-disc devices. CASE SUMMARY: A 50-year-old man, a pentathlon athlete, suffering from a previous left-sided ischemic stroke, underwent percutaneous closure of a permanent right-to-left shunt via PFO with a large fenestrated septum primum aneurysm at another institution. The NobleStitch® system was successfully implanted using local anesthesia and under angiographic-fluoroscopic monitoring. He was discharged home on aspirin 100 mg daily with a moderate residual shunt on contrast transthoracic echocardiography (cTTE) that persisted unaltered at subsequent controls. After 7 months, unable to resume sporting activity because of physical discomfort and dyspnea on exertion, the patient asked for a second opinion at our Heart and Brain clinic. Two-dimensional (2D) TTE showed septum primum laceration next to a radiopaque polypropylene knot with a moderate bidirectional shunt located at the fenestrated septum primum far from the PFO site. A catheter-based closure of the septal defect was therefore planned under local anesthesia and rotational intracardiac echo monitoring. An equally sized discs 28.5 mm × 28.5 mm Flex II UNI occluder (Occlutech GmbH, Jena, Germany) was successfully implanted across the atrial septal defect without complications. The patient was discharged in good clinical conditions; dual antiplatelet therapy (aspirin 100 mg/daily and clopidogrel 75 mg/daily) was recommended for 2 months and then single antiplatelet therapy (aspirin100 mg/daily) up to 6 months. Abolition of the residual shunt was confirmed at 1- and 6-month follow-up by contrast transcranial Doppler and 2D color Doppler cTTE. DISCUSSION: Closing a PFO with a suture-base system, without leaving a device implant behind, may be a cutting-edge technology and potential alternative to traditional devices. Nevertheless, meticulous selection of the PFO anatomies by 2D TEE is key to a successful closure procedure in order to avoid complications that must be managed again with a second percutaneous procedure or by surgery. Frontiers Media S.A. 2023-03-30 /pmc/articles/PMC10097917/ /pubmed/37063961 http://dx.doi.org/10.3389/fcvm.2023.1095661 Text en © 2023 Onorato, Grancini, Monizzi, Mastrangelo, Fabbiocchi and Bartorelli. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Onorato, Eustaquio Maria
Grancini, Luca
Monizzi, Giovanni
Mastrangelo, Angelo
Fabbiocchi, Franco
Bartorelli, Antonio L.
Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report
title Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report
title_full Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report
title_fullStr Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report
title_full_unstemmed Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report
title_short Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report
title_sort noblestitch® system for pfo closure: a novel but judicious alternative to traditional devices—a case report
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10097917/
https://www.ncbi.nlm.nih.gov/pubmed/37063961
http://dx.doi.org/10.3389/fcvm.2023.1095661
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