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May 21, 2008

Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defect

JAMA. 2008;299(19):2272-2273. doi:10.1001/jama.299.19.2272-a

To the Editor: In their Research Letter, Dr Opotowsky and colleagues1 reported an increase in percutaneous closure of interatrial defects. There are a number of points that we believe need to be considered in interpreting the data presented in their article.

Patent foramen ovale (PFO) and atrial septal defect (ASD) were classified together in the analysis, so specific comment on the indication for closure should be cautious. In addition, the observation that the rate of interatrial shunt closure has increased disproportionate to coronary revascularization following the introduction of stents needs to be viewed in context. This is due in part to far fewer PFO/ASD closures being performed in comparison with coronary revascularization at the commencement of the relevant periods. This increase is also likely to be magnified by significant improvements in equipment, devices, operator training, and lesion identification.