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Updated: May 29, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Impact of Patent Foramen Ovale Anatomical Complexity on Fluoroscopy Time During Transcatheter Closure
Ayşe İrem Demirtola1, Duygu Inan2, Anar Mammadli3
1Department of Cardiology, University of Health Sciences Ankara City Hospital, Ankara.
Background:
Complex patent foramen ovale (PFO) anatomical features can increase procedural difficulty during transcatheter closure, often leading to prolonged fluoroscopy time.
Aim:
This study aimed to evaluate the relationship between PFO anatomy, assessed via transesophageal echocardiography (TEE), and prolonged fluoroscopy time during transcatheter closure.
Methods:
This retrospective study analyzed 83 patients (median age: 45 years, 58% male) undergoing PFO closure for cryptogenic stroke. TEE measurements included key anatomical parameters related to PFO morphology and shunting dynamics. Patients were categorized into prolonged (≥ 80th percentile) and standard (< 80th percentile) fluoroscopy-time groups. Logistic regression, Pearson correlation analysis, and receiver operating characteristic (ROC) curve analyses were used to identify predictors of prolonged fluoroscopy time.
Results:
The prolonged fluoroscopy-time group had a significantly longer tunnel length (17.5 mm [interquartile range (IQR): 14.25-20.75] vs. 12.0 mm [IQR: 8.00-14.00], p < 0.01) and smaller aortic rim (3.0 mm [IQR: 2.0-3.75] vs. 6.0 mm [IQR: 5.0-8.0], p < 0.01). Fluoroscopy time correlated positively with tunnel length (r = 0.72, p < 0.001) and negatively with aortic rim length (r = -0.65, p < 0.001). Logistic regression identified tunnel length (odds ratio [OR] = 1.459; 95% confidence interval [CI]: 1.190-1.789) and aortic rim length (OR = 0.537; 95% CI: 0.378-0.764) as independent predictors. ROC curve analysis revealed a cut-off of 12.5 mm (area under the curve [AUC] = 0.770) for tunnel length and 5.5 mm (AUC = 0.798) for aortic rim in predicting prolonged fluoroscopy time.
Conclusions:
The findings of this study suggest that complex PFO anatomical features significantly impact fluoroscopy time, underscoring the need for detailed pre-procedural TEE assessments to optimize procedural planning and outcomes.
