Incidence of Aortic Valve Regurgitation and Outcome after Percutaneous Closure of Atrial Septal Defects and Patent Foramen Ovale

Steffen P Schoen ^1*, Alessandra Boscheri ¹, Stefan A Lange ¹, Martin U Braun ¹, Joerg F Fuhrmann ¹, Utz Kappert ² and Ruth H Strasser ¹

¹ Heart Center, Department of Cardiology, University of Technology, Dresden, Germany
² Heart Center, Department of Cardiosurgery, University of Technology, Dresden, Germany

^* To whom correspondence should be addressed. E-mail: cardiology{at}email.de.

Accepted 13 November 2007

Abstract

Aims In recent years percutaneous, transcatheter closure of atrial septal defects (ASD) or patent foramen ovale (PFO) was introduced into clinical practice. To our knowledge, no longitudinal follow up study investigated the functional effects on heart valves caused by an interatrial closure device.

Methods and Results Between 2001 and 2006, 240 consecutive patients underwent percutaneous closure of an ASD or a PFO. Heart valve functions were defined by transesophageal echocardiography pre implantation and three, six and twelve months after defect closure. A primarily successful implantation procedure was performed in 98% of patients. Sufficient closure without residual shunt could be achieved in 89 % of patients with ASD and in 92% of patients with PFO. An overall major complication rate of 0,8% was apparent during the observation time (mean 27±15 months). Long-term follow up revealed newly developed or worsened aortic valve regurgitation (AR) in 9% of patients with ASD and in 10% of patients with PFO. A potential cause for developing AR may be tissue overgrowing of the device leading to changes in interatrial septal geometry and traction on the root of the non-coronary aortic cusp.

Conclusion AR occurred in 9% of patients with closed ASD and in 10% of patients with closed PFO. Indication for closure should consider this potential complication despite an otherwise safe interventional procedure.

Keywords: aortic valve regurgitation, atrial septal defect, long-term follow up, patent foramen ovale, percutaneous defect closure

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