Journal of the American College of Cardiology Ó 2014 by the American College of Cardiology Foundation Published by Elsevier Inc.

Vol. 63, No. 5, 2014 ISSN 0735-1097/$36.00


Patent Foramen Ovale Closure Challenged by Left Atrial Chord Smita R. Jategaonkar, MD, Nikola Bogunovic, MSC, Dieter Horstkotte, MD, PHD, Werner Scholtz, MD Bad Oeynhausen, Germany

From the Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Manuscript received May 15, 2013; revised manuscript received July 2, 2013, accepted July 30, 2013.

n a 22-year-old woman suffering from ischemic stroke affecting the posterior cerebral artery, clinical work-up ruled out cardiovascular and neurological pathologies except patent foramen ovale (PFO) with septal aneurysm and complete bubble filling of the left atrium as demonstrated by echocardiography. The patient was scheduled for transcatheter PFO closure. Peri-interventional 3dimensional transesophageal echocardiography revealed a PFO tunnel and a left atrial chord keeping the PFO open, with consequent continuous left to right shunting (A to C; Online Video 1). Balloon sizing demonstrated a tunnel diameter of 16 mm (D). A 16-mm Amplatzer ASD occluder (St. Jude Medical, St. Paul, Minnesota) was implanted (E and F, Online Video 2) adhering to the atrial chord. Intraprocedural imaging was extremely helpful for device selection and positioning of the left atrial occluder disk to facilitate partial coverage and slightly lifting of the chord, yet no longer directly adjacent to the interatrial septum (E and F). No residual shunt was detected by final contrast angiogram.


Patent foramen ovale closure challenged by left atrial chord.

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