Only transesophageal echocardiography guided patent foramen ovale closure: A single-center experience

Area of Science:

• Cardiology
• Neurology
• Interventional Radiology

Background:

• Patent foramen ovale (PFO) is associated with recurrent stroke in certain patient populations.
• PFO occlusion is a therapeutic option to reduce stroke recurrence, but optimal guidance techniques require further investigation.
• Comparing transesophageal echocardiography (TEE) and angiographic guidance for PFO closure is crucial for procedural optimization.

Purpose of the Study:

• To compare the efficacy and safety of TEE guidance versus angiographic guidance for PFO closure.
• To evaluate procedural success rates, duration, complications, and long-term outcomes including residual shunt and recurrent cerebral ischemia.
• To determine if TEE-guided PFO closure can be performed without fluoroscopy and contrast media.

Main Methods:

• A retrospective study of 120 patients undergoing PFO closure between April 2019 and March 2021.
• Patients were divided into two groups: TEE guidance (65 patients) and angiographic guidance (55 patients).
• Key outcomes included procedural success, time, complications, and 12-month follow-up for atrial fibrillation, residual shunt, and recurrent cerebral ischemia.

Main Results:

• TEE guidance demonstrated a significantly higher procedural success rate (100% vs. 92.7%, P=0.028) and shorter procedural time (23.15±13.87 vs. 25.75±7.19 min, P=0.001).
• No significant differences were observed in procedural complication rates, new-onset atrial fibrillation, residual shunt, or recurrent cerebral ischemia at 12 months between the groups.
• Specifically, residual shunt occurred in 1.5% of the TEE group versus 5.5% of the angiographic group (P=0.236).

Conclusions:

• Intra-procedural TEE guidance for PFO closure is a safe and effective technique.
• TEE guidance offers advantages in procedural success and efficiency, potentially without increasing complications or adverse events.
• The study supports the feasibility of TEE-guided PFO closure without fluoroscopy or contrast media, with satisfactory short- and medium-term outcomes.