Related Experiment Video
Updated: Jan 14, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Device Embolization After Transcatheter Patent Foramen Ovale Closure: The Importance of Tunnel Width Assessment
Andrew C Peters1, Nicholas Ruggiero1, Tanuka Datta2
1Division of Cardiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Background:
Patent foramen ovale (PFO) is associated with cryptogenic stroke. Guidelines recommend PFO closure over medical therapy in patients aged 18 to 60.
Case Summary:
A 40-year-old woman underwent PFO closure at an outside institution, which was complicated by device embolization. Using three-dimensional (3D) transesophageal echocardiography (TEE) to assess PFO tunnel width revealed a larger PFO and guided closure with a 35-mm occlusion device instead of a 25-mm device.
Why Beyond The Guidelines:
Manufacturer guidelines recommend PFO occlusion device sizing based on tunnel length, which resulted in inappropriate sizing. This report presents the use of PFO tunnel width for device sizing.
Discussion:
This case report highlights the importance of 3D TEE assessment of PFO tunnel width and length to ensure successful percutaneous PFO closure. Reduction of stroke risk is predicated on eliminating right-to-left shunting. Device sizing based on tunnel width resulted in successful outcomes.
Take-Home Messages:
Percutaneous PFO closure is recommended over medical therapy for cryptogenic stroke in patients younger than 60 years. Appropriate closure device selection was enhanced with the use of multiplanar 3D TEE to assess PFO tunnel width.
