Related Experiment Video
Updated: Jun 29, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Complex Patent Foramen Ovale: Anatomic Variants, Technical Considerations, and Outcomes
Sant Kumar1, Ahmad Jabri2, Arturo Giacaman Saavedra3
1Department of Cardiology, Creighton University School of Medicine, Phoenix, AZ.
Insights
Patent foramen ovale (PFO) closure effectively reduces stroke risk in complex cases. Advanced imaging and techniques improve device deployment and patient outcomes for challenging PFO anatomies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Patent foramen ovale (PFO) closure is a standard procedure for cryptogenic stroke prevention.
- Complex PFO anatomies present significant challenges to device deployment and successful closure.
- Existing literature lacks comprehensive reviews on managing these complex anatomical variants.
Purpose of the Study:
- To review current evidence and procedural strategies for patent foramen ovale closure in complex anatomies.
- To highlight advancements in imaging and interventional techniques for challenging PFO cases.
- To discuss device selection and optimization for improved patient safety and efficacy.
Main Methods:
- Review of contemporary evidence on PFO closure techniques for complex anatomies.
- Analysis of imaging modalities (TEE, ICE, 3D imaging) for characterizing complex PFO variants.
- Evaluation of interventional approaches including tunnel angioplasty and transseptal puncture.
Main Results:
- Advanced imaging significantly improves detection and characterization of complex PFO features.
- Tailored procedural approaches and device selection lead to acceptable success rates.
- Favorable long-term clinical outcomes are achievable even in complex PFO cases.
Conclusions:
- Complex PFO anatomies require specialized techniques and imaging for successful closure.
- Current advancements enable safe and effective PFO closure with favorable outcomes.
- Continued innovation is crucial for further optimizing complex PFO closure procedures.
Abstract:
Patent foramen ovale (PFO) closure is a common intervention aimed at reducing recurrent stroke in patients with cryptogenic embolism. Complex PFO anatomies, characterized by features such as long tunnels, large defect sizes, atrial septal aneurysms, multifenestrated septa, prominent Eustachian valves or Chiari networks, and rigid or thickened septal tissue, pose significant challenges for successful device deployment and closure. Advances in imaging technologies, including transesophageal echocardiography, intracardiac echocardiography, and 3-dimensional imaging, have significantly enhanced the detection and characterization of these complex variants. This review summarizes contemporary evidence and procedural approaches tailored to overcome anatomic complexities, highlighting techniques such as tunnel angioplasty and transseptal puncture, alongside device selection considerations. Such advancements have led to acceptable procedural success rates and favorable long-term clinical outcomes. Ongoing innovations and dedicated research are essential to optimize these techniques further, improving patient safety and efficacy in complex PFO closure procedures.
