Percutaneous Patent Foramen Ovale Closure and Aneurysm Elimination by Direct Suture

Patent foramen ovale (PFO) with significant atrial septal aneurysm (ASA) may pose technical challenges. In selected cases, direct-suture closure may represent an effective alternative to close the PFO and reduce aneurysmal redundancy.

A 54-year-old woman with recurrent transient ischemic episodes and hyperintensity changes on magnetic resonance imaging was referred for percutaneous PFO closure. Transesophageal echocardiography demonstrated right-to-left shunt and markedly aneurysmal interatrial septum with constant rightward displacement. Under echocardiographic guidance, the septum was displaced leftward using a transseptal sheath, allowing wire passage. The PFO was subsequently closed with direct sutures, eliminating the ASA by creating a loop on the right atrial side.

Direct-suture closure can be considered even in the presence of large ASA, as it not only allows effective PFO closure but also reduction of aneurysmal redundancy.

Direct-suture percutaneous PFO closure can successfully and safely be performed in patients with ASA.