Advances in Percutaneous Patent Foramen Ovale Closure: From the Procedure to the Echocardiographic Guidance

Abstract

Percutaneous patent foramen ovale (PFO) closure by traditional, double disc occluder devices was shown to be safe for patients with PFO, and more effective than prolonged medical therapy in preventing recurrent thromboembolic events. The novel suture-mediated “deviceless” PFO closure system overcomes most of the risks and limitations associated with the traditional PFO occluders, appearing to be feasible in most interatrial septum anatomies, even if data about its long-term effectiveness and safety are still lacking. The aim of the present review was to provide to the reader the state of the art about the traditional and newer techniques of PFO closure, focusing both on the procedural aspects and on the pivotal role of transesophageal echocardiography (TEE) in patient’s selection, peri-procedural guidance, and post-interventional follow-up.

Value of Intracardiac Echocardiography in the Interventional Closure of Patent Foramen Ovale with Adjacent Atrial Septal Defect

“…In recent years, the diagnosis and management of PFO have gained increasing attention. In patients with embolic stroke of undetermined source, transient ischemic attacks, and PFO-associated migraines, interventional closure proves more to be efective compared with anticoagulant therapy [8]. With results from international randomized controlled studies on transcatheter closure of PFO versus pharmacological treatment, transcatheter closure of PFO has been recommended by many domestic and international guidelines [4,[9][10][11][12].…”

Patent foramen ovale closure with NobleStitch EL system in a case of Ebstein's anomaly after a failed device closure attempt

“…An aneurysmatic interatrial septum is considered a relative contraindication, because of the high risk of residual shunt after the sutures deployment. 4 However, in some circumstances, the NobleStitch EL may be used also in unfavorable PFO anatomy, above all if a partial closure is desired. Therefore, a combined use of NobleStitch EL and device was described to achieve a complete PFO closure in cases with complex anatomy wherein both the Noble-Stitch EL and the occluder devices are not able to achieve a complete closure on their own.…”

“…Usually, an aneurysmatic interatrial septum is considered a contraindication to use the NobleStitch EL system to close the PFO. 4 However, in this circumstance, a potential residual PFO shunt (due to the aneurysmatic septum) was considered acceptable, indeed desired. The NobleStitch EL suture was adequately deployed on the septum secundum and primum.…”

“…However, a complex anatomy of the PFO may sometimes compromise a device closure. 4 We describe the case of a patient with Ebstein anomaly, and a PFO-related arterial desaturation who underwent an effective suture-mediated NobleStitch EL system (Kardia, Milan, Italy) PFO closure after a failed attempt at device deployment.…”

Percutaneous closure of simple congenital heart diseases under echocardiographic guidance

“…When choosing a PFO occluder, attention should be paid to the size of the left atrium to avoid affecting the opening of the occluder or causing serious complications such as arrhythmia or left atrial rupture. Taken together, numerous researchers and our heart center experience (78 patients with a success rate of 100% and no postoperative adverse events) have shown that percutaneous TEE-guided PFO closure is a safe and reliable treatment method, and will be promoted and evaluated in global heart centers [ 40 – 43 ].…”