Related Experiment Video
Updated: May 5, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Contrast-Enhanced Transcranial Doppler for Detecting Residual Leaks-A Single-Center Study on the Effectiveness of
Malwina Smolarek-Nicpoń1, Grzegorz Smolka1, Aleksandra Michalewska-Włudarczyk2
1Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
Insights
Patent foramen ovale (PFO) closure follow-up is essential. Contrast-enhanced transcranial Doppler (ce-TCD) effectively identifies residual leaks after PFO closure, guiding further treatment decisions.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- A patent foramen ovale (PFO) is an atrial connection present in ~25% of the population.
- PFO closure is indicated for embolic stroke of undetermined source (ESUS) or TIA in patients <60 years.
- Post-closure follow-up monitors device position, closure efficacy, and thrombus formation.
Purpose of the Study:
- To evaluate the effectiveness of percutaneous PFO closure using echocardiography and ce-TCD.
- To assess long-term efficacy and identify residual embolic risk.
- To determine the role of ce-TCD in detecting post-procedural complications.
Main Methods:
- Analysis of 75 patients undergoing percutaneous PFO closure with ≥1 year follow-up.
- Fluoroscopy and transesophageal echocardiography (TEE) for procedures; TEE for size selection.
- Transthoracic echocardiography (TTE) at 1 and 6-12 months; ce-TCD at 12 months to detect high-intensity transient signals (HITSs).
Main Results:
- No device dislodgement, thrombi, or residual leaks detected by TTE at follow-up.
- ce-TCD identified HITSs in 8 patients; subsequent TEE confirmed residual leaks in 5 of 7 cases.
- Two patients with grade 2 HITSs had confirmed leaks, indicating potential residual embolic risk.
Conclusions:
- Assessing PFO occluder effectiveness is critical for managing residual embolic risk and antithrombotic therapy.
- ce-TCD, even with low-grade HITSs, aids in identifying patients with residual leaks.
- Early detection of leaks via ce-TCD and TEE can guide appropriate clinical management.
Abstract:
Background: A persistent connection between the atria, known as a patent foramen ovale (PFO), is present in approximately 25% of the general population. PFO closure is indicated in patients under 60 years of age who have experienced an embolic stroke of undetermined source (ESUS) or transient ischemic attack (TIA) confirmed by neurological imaging, and in selected cases of peripheral embolism. Follow-up after the procedure is indicated to confirm the position of the occluder, assess the effectiveness of the closure, and evaluate any potential thrombus formation on the device. Methods: We analyzed data from 75 consecutive patients who underwent percutaneous PFO closure procedures and were followed up for at least one year. The procedure was performed under fluoroscopy and transesophageal echocardiography (TEE) guidance, and occluder size selection was made using TEE multiplanar imaging (MPR). All patients had standard transthoracic echocardiography (TTE) at 1 and 6-12 months after the procedure. To assess the long-term efficacy, contrast-enhanced transcranial Doppler (ce-TCD) was performed at 12 months to record high-intensity transient signals (HITSs). Cases with positive ce-TCD had TEE performed. Results: During follow-up evaluations after 1 and 6-12 months (TTE), we did not observe any device dislodgements, thrombi, or residual leaks visible in TTE. ce-TCD detected HITSs in eight patients, prompting additional TEE examinations performed in seven cases. In five out of seven patients, a leak around the occluder was identified, including two patients with grade 2 HITSs. Conclusions: Assessing the effectiveness of PFO occluder placement is crucial for the residual embolic risk and thus the necessity of antithrombotic therapy. Even low grades of HITSs observed in ce-TCD help to identify patients with residual leaks confirmed in TEE.
