# Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defect in Athletes: A Study With a Long‐Term Follow‐Up

## TL;DR

This study shows that closing heart defects in athletes is as safe as in non-athletes over a long period, even for high-risk sports.

## Contribution

Demonstrates the long-term safety of percutaneous PFO/ASD closure in athletes, addressing a gap in existing data.

## Key findings

- No device dislocation occurred in athletes during long-term follow-up.
- Bleeding events were similar between athletes and non-athletes.
- Sports participation did not increase complication risks in athletes.

## Abstract

Patent foramen ovale (PFO) and atrial septal defect (ASD) percutaneous closure is routinely performed. However, data on long‐term safety and efficacy in athletes are lacking. This study with a long‐term follow‐up investigated the safety and efficacy of percutaneous PFO/ASD closure in athletes compared to non‐athletes, focusing on the impact of sports participation on complications. The study included individuals < 50 years old undergoing percutaneous PFO/ASD closure. Athletes practiced sports for ≥ 4 h/week for ≥ 2 consecutive years before and after the procedure. Periprocedural complications, device dislocation, and bleeding events were assessed during a long‐term follow‐up (mean 10.6 ± 5.1 years). Echocardiography, including transcranial Doppler bubble test, was performed before discharge, at 1 and 3 months, and yearly thereafter. Seventy‐six patients (36 athletes and 40 non‐athletes) were included. Fourteen patients practiced sports at risk of trauma, and no differences in periprocedural complications were observed between the two groups. During the follow‐up, no device dislocation was observed in athletes. A single major bleeding occurred in a non‐athlete during dual antiplatelet therapy (DAPT). Eight minor bleedings occurred (4 during DAPT, 4 during single antiplatelet therapy—SAPT), with no significant difference between athletes and non‐athletes (p = 0.23 and p = 0.79, respectively). One minor sports‐related bleeding (muscular hematoma) occurred during SAPT in an athlete practicing kickboxing. Percutaneous PFO/ASD closure is safe in athletes, with no differences in complication rates between athletes and non‐athletes observed during long‐term follow‐up (> 10 years). Sports participation did not significantly increase the bleeding risk, even in athletes practicing sports at risk of trauma.