175. Percutaneous closure of interatrial septal defects in pregnancy: Experience at John Radcliffe Hospital (UK)

Introduction Patent foramen ovale (PFO) and atrial septal defects (ASD) are common congenital cardiac defects in adults, which may cause complications in pregnancy such as paradoxical embolism. Closure of PFO/ASDs in pregnancy is rarely necessary, but has been suggested as a safe option in selected patients under expert hands. Objective To review the outcomes and follow-up of patients who underwent percutaneous device closure of PFO/ASD during pregnancy at John Radcliffe Hospital since 2005. Methods Retrospective review of all medical and obstetric notes of patients that fulfilled inclusion criteria. Helex® device was used in all patients. Procedures were performed with local anaesthesia under intracardiac echocardiography guidance (ICEG) and low frame rate fluoroscopy with a highly collimated beam. Results Twelve women were included, 3 (25%) with ASD, 9 (75%) with PFO. Average age was 31 [24-41]. None of the patients had clinical deep vein thrombosis (DVT) at diagnosis. Half of patients had a negative thrombophilia screen, and one resulted lupus anticoagulant positive. Indications for the procedure were: TIA (33.3%), stroke (33.3%), severe migraine (25%), myocardial infarction (8%). Successful PFO/ASD closure was achieved in all patients. Average radiation dose was 39 cGy/cm[b] [2.3–260], with estimated uterine/fetal dose of less than 0.001 mGy. Median gestation age was 19 weeks [10–31]. All women received aspirin 75 mg daily for 6 months after procedure. Of those, 25% had aspirin+ dypiridamol/clopidogrel, 17% aspirin+ prophylactic low molecular weight heparin (LMWH), 8% aspirin+ therapeutic LMWH. Follow up period was 6 years [1–10]. Eleven women (92%) had no recurrent symptoms; one patient had migraine. No medical nor obstetric complications were observed except preeclampsia in one patient. Discussion Overall, high rate of successful procedures and low rate of complications were seen. In conclusion, closure of PFO/ASDs in selected pregnant patients can be performed safely, if these women develop complications secondary to them.