Suture-mediated patent foramen ovale* closure: The NobleStitch technique

Background

In September 1997, in Switzerland, Bernhard Meier and Kurt Amplatz for the first time closed a patent foramen ovale (PFO) by using a self-expanding double disc lined with thin polyester fabric (the AMPLATZER™ PFO Occluder; St. Jude Medical, St. Paul, MN, USA). Since then, the therapeutic approach to patients with paradoxical embolism through a PFO has changed radically. Despite this revolutionary technical improvement, it took 20 years to convince the medical community of the pathogenic link between PFO and cerebral events and that percutaneous closure of PFO was superior to medical therapy to treat patients with so-called cryptogenic stroke. Indeed, after a huge number of non-controlled observational, retrospective studies and meta-analyses suggesting the efficacy of PFO closure in the prevention of recurrent cerebral ischaemia, only in September 2017 did three randomised controlled multicentre studies show that percutaneous closure of the atrial communication represents a more effective therapy than prolonged medical treatment (Table 1) 11. Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Béjot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber...