Clinical efficacy of percutaneous patent foramen ovale closure guided by transesophageal echocardiography_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QU Haonan ¹ , XU Peng ¹ , JIA Jie ¹ , WANG Jian ² , YE Hongmei ² , ZOU Xin ³ , ZHANG Diwen ³ ,  ZHAO Xiongfei ¹

1. Department of Cardiothoracic Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, 621000, Sichuan, P. R. China;
2. Department of Ultrasonic Diagnosis, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, 621000, Sichuan, P. R. China;
3. Department of Neurology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, 621000, Sichuan, P. R. China;

Corresponding author：

ZHAO Xiongfei, Email: 853183685@qq.com

Keywords：

Patent foramen ovale; transesophageal echocardiography; closure; efficacy

DOI：

10.7507/1007-4848.202307067

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Objective To analyze the efficacy and safety of closure of patent foramen ovale (PFO) guided by transesophageal echocardiography (TEE), and summarize the experience of some difficult cases. Methods The patients who underwent the percutaneous PFO occlusion in our hospital from January 2020 to May 2023 were retrospectively enrolled. Dynamic monitoring data of TEE before, during, and after the operation were recorded. Results A total of 68 patients including 30 males and 38 females at an average age of (45.6±16.3) years were included. There were 7 patients with complex PFO. Under TEE guidance, 65 patients successfully completed the occlusion treatment, with an average operation time of (55.6±26.2) min and hospital stay time of (4.2±1.1) d, and 3 patients failed to close. During the operation, the two-dimensional TEE images of the patients were clear, which fully and clearly showed the process of the sheath canal passing through the foramen ovale and the continuous observation of the occlusive umbrella after releasing the occlusive umbrella. The position of the umbrella was secure and the shape of the umbrella was satisfactory. No blood shunt or pericardial effusion was found at 6-month and 1-year follow-up. The heart structure and heart rhythm were improved, the atrioventricular valve function was normal, the blocking umbrella was firm and stable, and there was no shedding or displacement. Conclusion The percutaneous PFO occlusion guided by TEE is safe and effective, and has fewer side effects on patients compared with traditional interventional methods, but the complex PFO occlusion surgery is still challenging.

Citation： QU Haonan, XU Peng, JIA Jie, WANG Jian, YE Hongmei, ZOU Xin, ZHANG Diwen, ZHAO Xiongfei. Clinical efficacy of percutaneous patent foramen ovale closure guided by transesophageal echocardiography. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(9): 1284-1288. doi: 10.7507/1007-4848.202307067 Copy

1.	Homma S, Messé SR, Rundek T, et al. Patent foramen ovale. Nat Rev Dis Primers, 2016, 2: 15086.
2.	Mojadidi MK, Zaman MO, Elgendy IY, et al. Cryptogenic stroke and patent foramen ovale. J Am Coll Cardiol, 2018, 71(9): 1035-1043.
3.	中华医学会心血管内科分会, 中国医师协会心血管内科分会. 卵圆孔未闭预防性封堵术中国专家共识. 中国循环杂志, 2017, 32(3): 209-214.Chinese Society of Cardiology of Chinese Medical Association, Chinese College of Cardiovascular Physicians. Chinese expert consensus on prophylactic closure of patent foramen ovale. Chin Circ J, 2017, 32(3): 209-214.
4.	Gonnah AR, Bharadwaj MS, Nassar H, et al. Patent foramen ovale: diagnostic evaluation and the role of device closure. Clin Med (Lond), 2022, 22(5): 441-448.
5.	Shi F, Sha L, Li H, et al. Recent progress in patent foramen ovale and related neurological diseases: a narrative review. Front Neurol, 2023, 14: 1129062.
6.	Kumar P, Kijima Y, West BH, et al. The connection between patent foramen ovale and migraine. Neuroimaging Clin N Am, 2019, 29(2): 261-270.
7.	中国医师协会神经内科医师分会, 中国研究型医院学会头痛与感觉障碍专业委员会. 中国偏头痛诊治指南(2022版). 中国疼痛医学杂志, 2022, 28(12): 881-898.Chinese Association of Neurologists, Committee of Headache and Sensation Disorders of Chinese Research Hospital Association. Chinese guidelines for the diagnosis and treatment of migraine (2022 edition). Chin J Pain Med, 2022, 28(12): 881-898.
8.	Del Sette M, Angeli S, Leandri M, et al. Migraine with aura and right-to-left shunt on transcranial Doppler: a case-control study. Cerebrovasc Dis, 1998, 8(6): 327-330.
9.	Kolte D, Palacios IF. Patent foramen ovale closure for secondary prevention of cryptogenic stroke. Expert Rev Cardiovasc Ther, 2021, 19(3): 211-220.
10.	Cao Q, Shen Y, Hou Z, et al. The relationship between patent foramen ovale and unexplained dizziness: a prospective analysis in China. Neuropsychiatr Dis Treat, 2022, 18: 1495-1505.
11.	Badea RŞ, Ribigan AC, Grecu N, et al. Differences in clinical and biological factors between patients with PFO-related stroke and patients with PFO and no cerebral vascular events. Front Neurol, 2023, 14: 1104674.
12.	Bridges ND, Latson L, Filiano J, et al. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation, 1992, 86(6): 1902-1908.
13.	Rao PS. Outcomes of device closure of atrial septal defects. Children (Basel), 2020, 7(9): 111.
14.	Sperlongano S, Giordano M, Ciccarelli G, et al. Advances in percutaneous patent foramen ovale closure: from the procedure to the echocardiographic guidance. J Clin Med, 2022, 11(14): 4001.
15.	Collado FMS, Poulin MF, Murphy JJ, et al. Patent foramen ovale closure for stroke prevention and other disorders. J Am Heart Assoc, 2018, 7(12): e007146.
16.	中国医师协会心血管内科医师分会结构性心脏病学组, 心源性脑卒中人群的高危预测模型及治疗策略的临床研究课题组. 卵圆孔未闭超声诊断中国专家共识. 中国介入心脏病学杂志, 2023, 31(1): 4-11.Chinese College of Cardiovascular Physicians Structural Cardiology Group, Clinical Study Group on High-risk Prediction Model and Treatment Strategy of Cardiogenic Stroke Population. Chinese expert consensus on ultrasound diagnosis of patent foramen ovale. Chin J Intervent Cardiol, 2023, 31(1): 4-11.
17.	Gaspardone A, De Marco F, Sgueglia GA, et al. Novel percutaneous suture-mediated patent foramen ovale closure technique: early results of the NobleStitch EL Italian Registry. EuroIntervention, 2018, 14(3): e272-e279.
18.	Beneduce A, Ancona MB, Moroni F, et al. A systematic transoesophageal echocardiography study of suture-mediated percutaneous patent foramen ovale closure. EuroIntervention, 2022, 18(1): 63-67.

1. Homma S, Messé SR, Rundek T, et al. Patent foramen ovale. Nat Rev Dis Primers, 2016, 2: 15086.
2. Mojadidi MK, Zaman MO, Elgendy IY, et al. Cryptogenic stroke and patent foramen ovale. J Am Coll Cardiol, 2018, 71(9): 1035-1043.
3. 中华医学会心血管内科分会, 中国医师协会心血管内科分会. 卵圆孔未闭预防性封堵术中国专家共识. 中国循环杂志, 2017, 32(3): 209-214.Chinese Society of Cardiology of Chinese Medical Association, Chinese College of Cardiovascular Physicians. Chinese expert consensus on prophylactic closure of patent foramen ovale. Chin Circ J, 2017, 32(3): 209-214.
4. Gonnah AR, Bharadwaj MS, Nassar H, et al. Patent foramen ovale: diagnostic evaluation and the role of device closure. Clin Med (Lond), 2022, 22(5): 441-448.
5. Shi F, Sha L, Li H, et al. Recent progress in patent foramen ovale and related neurological diseases: a narrative review. Front Neurol, 2023, 14: 1129062.
6. Kumar P, Kijima Y, West BH, et al. The connection between patent foramen ovale and migraine. Neuroimaging Clin N Am, 2019, 29(2): 261-270.
7. 中国医师协会神经内科医师分会, 中国研究型医院学会头痛与感觉障碍专业委员会. 中国偏头痛诊治指南(2022版). 中国疼痛医学杂志, 2022, 28(12): 881-898.Chinese Association of Neurologists, Committee of Headache and Sensation Disorders of Chinese Research Hospital Association. Chinese guidelines for the diagnosis and treatment of migraine (2022 edition). Chin J Pain Med, 2022, 28(12): 881-898.
8. Del Sette M, Angeli S, Leandri M, et al. Migraine with aura and right-to-left shunt on transcranial Doppler: a case-control study. Cerebrovasc Dis, 1998, 8(6): 327-330.
9. Kolte D, Palacios IF. Patent foramen ovale closure for secondary prevention of cryptogenic stroke. Expert Rev Cardiovasc Ther, 2021, 19(3): 211-220.
10. Cao Q, Shen Y, Hou Z, et al. The relationship between patent foramen ovale and unexplained dizziness: a prospective analysis in China. Neuropsychiatr Dis Treat, 2022, 18: 1495-1505.
11. Badea RŞ, Ribigan AC, Grecu N, et al. Differences in clinical and biological factors between patients with PFO-related stroke and patients with PFO and no cerebral vascular events. Front Neurol, 2023, 14: 1104674.
12. Bridges ND, Latson L, Filiano J, et al. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation, 1992, 86(6): 1902-1908.
13. Rao PS. Outcomes of device closure of atrial septal defects. Children (Basel), 2020, 7(9): 111.
14. Sperlongano S, Giordano M, Ciccarelli G, et al. Advances in percutaneous patent foramen ovale closure: from the procedure to the echocardiographic guidance. J Clin Med, 2022, 11(14): 4001.
15. Collado FMS, Poulin MF, Murphy JJ, et al. Patent foramen ovale closure for stroke prevention and other disorders. J Am Heart Assoc, 2018, 7(12): e007146.
16. 中国医师协会心血管内科医师分会结构性心脏病学组, 心源性脑卒中人群的高危预测模型及治疗策略的临床研究课题组. 卵圆孔未闭超声诊断中国专家共识. 中国介入心脏病学杂志, 2023, 31(1): 4-11.Chinese College of Cardiovascular Physicians Structural Cardiology Group, Clinical Study Group on High-risk Prediction Model and Treatment Strategy of Cardiogenic Stroke Population. Chinese expert consensus on ultrasound diagnosis of patent foramen ovale. Chin J Intervent Cardiol, 2023, 31(1): 4-11.
17. Gaspardone A, De Marco F, Sgueglia GA, et al. Novel percutaneous suture-mediated patent foramen ovale closure technique: early results of the NobleStitch EL Italian Registry. EuroIntervention, 2018, 14(3): e272-e279.
18. Beneduce A, Ancona MB, Moroni F, et al. A systematic transoesophageal echocardiography study of suture-mediated percutaneous patent foramen ovale closure. EuroIntervention, 2022, 18(1): 63-67.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of percutaneous patent foramen ovale closure guided by transesophageal echocardiography

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