Patent foramen ovale closure in children without cardiopathy: Child-PFO study

Abstract

Background: Closure of patent foramen ovale is well-managed in adults, but is performed less frequently in children.

Aim: To analyse all patent foramen ovale closures performed in the past 20 years in French paediatric centres.

Methods: Retrospective study of patent foramen ovale closures in children without cardiopathy in nine centres between 2000 and 2019.

Results: Forty-one procedures were carried out in children (median age: 14.9 years). Thirty-one patent foramen ovales were closed after a transient ischaemic attack or stroke, six for a left-to-right shunt and four for other reasons. Transthoracic echocardiography was used for 72.2% of the diagnoses and transoesophageal echocardiography for 27.8%. A substantial degree of shunting was found in 42.9% of patients and an atrial septal aneurysm in 56.2%. General anaesthesia with transoesophageal echocardiography guidance was performed in 68.3% of the procedures; local anaesthesia and transthoracic echocardiography or intracardiac echocardiography was performed in 31.7%. The success rate was 100%. The median fluoroscopy time was 4.14minutes: 3.55minutes with transoesophageal echocardiography; and 4.38minutes with transthoracic echocardiography (P=0.67). There was only one periprocedural complication (2.4%). Postoperatively, 80,5% of patients were treated with aspirin and 12,2% with an anticoagulant. The rate of complete occlusion was 56.8% immediately after the procedure, 68.6% at 1 year and 92.3% at the last follow-up. There were no delayed complications or cases of recurrent stroke during follow-up (median follow-up: 568 days).

Conclusion: Closure of patent foramen ovale in children appears to be safe and effective, as we noted a low rate of immediate complications, no delayed complications and no stroke recurrence in this indication.

Keywords: Accident vasculaire cérébral; Fermeture percutanée; Foramen ovale perméable; Patent foramen ovale; Percutaneous closure; Stroke.