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

“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

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

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

  2. NO CONFLICT OF INTEREST TO DECLARE

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

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

  5. Basic anatomy

  6. 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

  7. Incomplete PFO closure

  8. Residual flow (AGA device)

  9. Papworth Hospital 2005 to 2008 241 consecutive pfo closures (271 devices) No late complication

  10. 3 balloon morphologies. ? LONG TUNNEL SHORT TUNNEL ? SHORT TUNNEL LONG TUNNEL

  11. Typical PFO – LA edge tunnel heightand widthflap separation with wire

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

  13. Narrow partial fixed split, long tunnel, narrow RA openingShortest tunnel segment 12.5mm Posterosuperior Anterosuperior

  14. Spontaneous flap retraction

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

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

  17. Typical PFO – tunnel height or flap separation

  18. Typical PFO – LA edge tunnel width with wire

  19. Long tunnel, partial fixed split, narrow flap separation

  20. Septal bounceFlap retraction

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

  22. 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

  23. 5mm distance disk to disk including disk thicknessApprox 3mm waist

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