A 'twice closed' patent foramen ovale: a case report of percutaneous management of a residual interatrial shunt in a patient with persistent migraine symptoms.

Residual interatrial shunt should be suspected in patients with persistent migraine and a history of percutaneous PFO closure. Fluoroscopic and TOE-guided closure of residual interatrial shunt with a second PFO occlude device seems to be a safe and clinically effective strategy to manage persistent migraine.