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Updated: Feb 19, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
A Practical Scoring System to Select Optimally Sized Devices for Percutaneous Patent Foramen Ovale Closure
Joseph M Venturini1, Elizabeth M Retzer1, J Raider Estrada1
1Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
Insights
A new scoring system helps select the correct device size for patent foramen ovale (PFO) closure. This aids in preventing cryptogenic stroke by improving percutaneous closure outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Patent foramen ovale (PFO) is linked to cryptogenic stroke.
- Percutaneous PFO closure improves outcomes but lacks device sizing guidelines.
- This study aimed to develop a predictive score for optimal device selection.
Purpose of the Study:
- To develop a predictive score for optimal device sizing in percutaneous patent foramen ovale closure.
- To identify patient characteristics and echocardiographic findings associated with device size.
Main Methods:
- Retrospective review of 36 patients undergoing percutaneous PFO closure (July 2010 - December 2014).
- Evaluation of demographic, clinical, and echocardiographic data.
- Analysis of factors associated with Amplatzer Septal Occluder (ASOC) device size.
Main Results:
- All 36 procedures were successful using ASOC devices (25, 30, 35 mm).
- Atrial septal aneurysm and PFO tunnel length >10 mm independently predicted larger device size.
- A scoring system (male sex, ASA, PFO tunnel length >10 mm) correlated with implanted device size (p=0.006).
Conclusions:
- A simple scoring system can guide optimal device selection for percutaneous PFO closure.
- This may improve procedural success and patient outcomes.
- Further validation of the scoring system is warranted.
Background:
Patent foramen ovale (PFO) has been linked to cryptogenic stroke, and closure has been reported to improve clinical outcomes. However, there are no clear guidelines to direct device sizing. This study sought to use patient characteristics and echocardiographic findings to create a prediction score for device sizing.
Methods:
This was a retrospective review of patients undergoing percutaneous PFO closure at our institution between July 2010 and December 2014. Demographic and clinical characteristics were recorded, and all pre- and intraprocedural echocardiography results were evaluated.
Results:
Thirty-six patients underwent percutaneous PFO closure during the study period. All procedures were performed using an Amplatzer Septal Occluder "Cribriform" (ASOC) device in one of three disc diameters: 25, 30, or 35 mm. Closure was indicated for cryptogenic stroke/transient ischemic attack in 75% of cases. Every case (100%) was successful with durable shunt correction at the 6-month follow-up without complications of erosion or device embolization. The presence of atrial septal aneurysm (ASA) (p = 0.027) and PFO tunnel length >10 mm (p = 0.038) were independently associated with increased device size. A scoring system of 1 point for male sex, 1 point for ASA, and 1 point for PFO tunnel >10 mm long was associated with the size of closure device implanted (p = 0.006).
Conclusions:
A simple scoring system may be used to select an optimally sized device for percutaneous PFO closure using the ASOC device.
