Related Experiment Video
Updated: Jul 10, 2026
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Simultaneous Transcatheter Closure of a Persistent Iatrogenic Atrial Septal Defect and Incidental Patent Foramen
Daisuke Kanda1, Yota Uchiyama1, Yoshihisa Horizoe1
1Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Objective:
To describe a transcatheter strategy for simultaneous closure of a persistent iatrogenic atrial septal defect (iASD) and adjacent patent foramen ovale (PFO) using a single Cribriform occluder in a patient with exertional hypoxemia.
Key Steps:
1) Preprocedural transesophageal echocardiography (TEE) and bubble study to assess both defects, quantify shunting, and their spatial relationship; 2) selective wire crossing of the iASD under real-time 3-dimensional TEE guidance; 3) deployment of a Cribriform occluder to bridge both adjacent defects; and 4) confirm device stability and adequate closure with postdeployment color Doppler and bubble study.
Potential Pitfalls:
The guidewire may preferentially cross the larger PFO rather than the smaller iASD. Careful assessment of the interdefect distance is essential because widely separated defects may require 2 occluders rather than a single bridging device.
Take-Home Messages:
Systematic TEE evaluation can identify a concomitant PFO before iASD closure. In anatomically suitable cases, simultaneous single-device closure can effectively eliminate right-to-left shunting.
