Closure of patent foramen ovale: technique, pitfalls, complications, and follow up

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Abstract
The PFO was initially considered by interventional cardiologists simply as one of the manifestations of an ASD to be left to their paediatric colleagues. However, about 10 years ago, it was realised that the PFO not only represented the most common form of an ASD but that it also exhibited its problems exclusively in adults and represented the easiest target for closure. A derivative of the Clamshell occluder was dedicated to PFO closure and named PFO STAR (Cardia, Burnsville, Minnesota, USA); the Amplatzer occluder was modified for the PFO indication and first implanted on 10 September 1997 by the author in the presence of Kurt Amplatz, the inventor. Like all Amplatzer occluder devices, it consists of a nitinol mesh double disk containing polyester fabric inside the two disks. The disks are connected by a thin neck formed by the woven wires forming the disks. The neck is twisted around its long axis and hence is extendable. The device has to be screwed on to a pusher/puller cable and pulled into an 8 or 9 French introducer sheath. When pushed out of the sheath, it resumes its disk shape instantly. The whole process is fully reversible, as many times as required, up to the moment the device is unscrewed from the pusher/puller cable.