Optimal device for children and closure indications in pediatric population

Abstract

Transcatheter patent foramen ovale closure has evolved into one of the most commonly performed structural interventions worldwide. Although the prevalence of patent foramen ovale may even be greater in children than adults, closure is rarely performed in this group despite susceptibility to similar defect-related morbidity. Despite an association with arterial ischemic stroke in approximately 5 % of cases and an overall stroke recurrence rate of 20 %, proof that device closure is superior to medical therapy will be significantly more challenging to prove than it has been in adult patients. Therefore as with many circumstances in interventional pediatric cardiology, treatment of patent foramen ovale in children lacks supportive data and practice varies considerably. This chapter will outline some of the indications for closure in a pediatric population, methods to circumvent some of the diagnostic challenges and a technical approach to closure in this age group.