Clinical observation of transcatheter patent foramen ovale closure in treatment of migraine

AIM To assess the safety and efficacy of transcatheter patent foramen ovale (PFO) closure in reducing or curing migraine with or without aura in PFO patients. METHODSPatients with migraine and PFO were consecutively enrolled in our department from May 2012 to June 2013 and all patients underwent PFO closure under general anesthesia after definite diagnosis of PFO by transthoracic echocardiography (TTE), transthoracic contrast echocardiography (TTCE) and, if necessary, by transesophageal echocardiography (TEE). Before and after PFO closure, patients were assessed by HIT-6 scores and their migraine symptoms including the frequency and degree of migraine were recorded. RESULTSA total of 32 patients (14 males and 18 females) aged 14-59 years (37.00±12.26) were enrolled in the study. There were 23 cases of migraine with aura (MA) and nine cases of migraine without aura (MO). In the 32 cases, 31 cases with the sign of PFO or right to left shunt were detected by TTCE and only one case was highly suspected by TEE, which was finally confirmed by TEE. The detection rate was 65.63% by TTE and 96.88% by TTE and TTCE. All patients successfully underwent transcatheter PFO closure and there were no complications. There were no attacks of migraine during hospitalization. Follow-up at 1, 3 and 6 months found no occluder displacement and residual shunt. Obvious right to left shunt was not observed by TTCE at 6 months. Follow-up results showed that HIT-6 scores were significantly reduced in patients with MA and MO after PFO closure (P<0.05). Influence of migraine on the quality of life significantly decreased and the average frequency and degree of migraine obviously reduced (P<0.05). CONCLUSIONTTCE can enhance the detection rate of PFO. Transcatheter PFO closure is safe and effective and can alleviate symptoms of migraine and its influence on quality of life.