Percutaneous reclosure of a patent foramen ovale after bioabsorbable device implantation

A 49-year-old woman, with a history of cryptogenic stroke and percutaneous patent foramen ovale (PFO) closure using a bioabsorbable device with a diameter of 28 mm, was seen in our outpatient clinic for contrast transthoracic echocardiography (TTE) at three-year follow-up. Earlier contrast TTE had shown a small right-to-left shunt. Currently, her clinical investigation was unremarkable. The TTE showed a good device position, without thrombi on the device. Colour Doppler showed no signs of shunting, but using contrast (Figure 1A) a severe right-to-left shunt was diagnosed during Valsalva. Under local anaesthesia and intracardiac echocardiographic guidance, the residual shunt was closed percutaneously using ...