Noblestitch Failure After Percutaneous Patent Foramen Ovale Closure in a Case Of Platypnea-Orthodeoxia Syndrome: Is this Device Suitable for All Patients?

Patent foramen ovale (PFO) is a common congenital cardiac lesion corresponding to a normal fetal interatrial communication that typically closes after birth with the fusion of the atrial septum primum to the septum secundum . When the foramen ovale persists, it is usually asymptomatic and benign, with no need for treatment. In rare cases, it can be implicated in the pathogenesis of some medical conditions, such as platypnea-orthodeoxia syndrome (POS). In this context, PFO closure may be indicated.

Several occluder devices, traditionally based on a double-disc design, have shown that percutaneous PFO closure is possible. Despite the proven efficacy, their use is not technically feasible for some patients. In addition, they have the potential to cause some complications. NobleStitch EL (NS) is an alternative percutaneous PFO closure technique available in Europe, European Commission (EC) marked for cardiovascular suturing and PFO closure, and in the US, with Food and Drug Administration (FDA) clearance for vascular and cardiovascular suturing. It consists of a “deviceless” system with two dedicated suture delivery catheters. ^, To date, the experience with the NS device is limited, and we still lack information about its failure determinants, which could help select patients. ^–