Influence of PFO Anatomy on Successful Transcatheter Closure

Onorato, Eustaquio; Casilli, Francesco

doi:10.1016/j.iccl.2012.09.009

Cited by 5 publications

(6 citation statements)

References 87 publications

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“…The usual tunnel‐like shape of PFO is determined by the extent to which the thin fibrous septum primum and the thick muscular secundum overlap. According to the tunnel shapes evaluated by TEE and previous research, 18 PFO was classified into four subtypes (Figure 2), 2D and CDFI images can be seen in Figure 3.…”

Section: Methodsmentioning

confidence: 98%

“…Eustachian valve (EV), Chiari network and thickening of septum secundum are important predictors of postprocedural residual shunt and stroke recurrence. [17][18][19] However, it is still unknown whether these are predictors of PFO closure.…”

Section: Introductionmentioning

confidence: 99%

“…According to its size, length and surrounding structures, the relevant guidelines have divided PFO into simple PFO and complex PFO. It was reported that large PFO, long‐tunnel PFO, associated atrial septal aneurysm (ASA), Eustachian valve (EV), Chiari network and thickening of septum secundum are important predictors of postprocedural residual shunt and stroke recurrence 17–19 . However, it is still unknown whether these are predictors of PFO closure.…”

Section: Introductionmentioning

confidence: 99%

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Effects of morphological characteristics of patent foramen ovale by transesophageal echocardiography on minimalist transcatheter closure in southern China

et al. 2023

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Objectives Transcatheter closure has become one of the main treatment methods for patent foramen ovale (PFO). However, the population in southern China is generally thin and the size of PFO is small, so the application of minimalist surgery is challenging. This study aimed to analyze the morphological characteristics of PFOs in southern China by transesophageal echocardiography (TEE), and to explore the influence on minimalist transcatheter closure. Methods About 110 patients with PFO closure in our hospital were selected. All cases were examined by TEE including the PFO size, length, septum secundum thickness, color characteristic and surrounding structures, and morphologically classified. During the operation, the procedure time, number of times for the guidewire attempting to pass the interatrial septum and the success rate of simply using J guidewire to cross the interatrial septum were recorded. Results About 110 cases of PFO were classified into two categories and four subtypes, including 55 cases with Uniform Channel Type (UCT, 50.0%), 16 cases with Irregular Channel Type (ICT, 14.6%), 15 cases with Right Funnel Type (RFT, 13.6%), and 24 cases with Left Funnel Type (LFT, 21.8%). According to the complexity of the procedure, they were divided into simple procedure (n = 73) and complex procedure (n = 37). Multivariate logistic regression showed that the anatomical types of PFO, the tunnel entrance size, and the tunnel entrance size <2 mm were independent factors affecting the complexity of procedure [OR = 2.819, 95% CI (1.124, 7.066), p = .027; OR = .027, 95% CI (.004, .208), p = .001; OR = 4.715, 95% CI (1.028, 21.619), p = .046]. With ICT and LFT groups, the procedure duration was relatively long (p < .001), number of times for the guidewire attempting to pass the interatrial septum was significantly increased (p < .001), and the success rate of simply using J guidewire to cross the interatrial septum was relatively low (p < .001). Conclusions The PFO size in southern China was relatively small and characterized by large tunnel tension. It was concluded that TEE could clearly show the morphological characteristics of PFO, which could provide guidance for making more reasonable surgical plans in clinical practice, shorten the procedure time and improve the success rate of PFO closure.

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Section: Methodsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of morphological characteristics of patent foramen ovale by transesophageal echocardiography on minimalist transcatheter closure in southern China

et al. 2023

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“…Previous studies have shown that about half of patients under 55 with CS are associated with paradoxical embolism from RLS through the PFO [1][2][3]. Simple PFO is defined as tunnel length (the distance between septum secundum and septum primum overlapping) less than 8 mm, and the thickness of septum secundum is less than 6 mm, without atrial septal aneurysm (ASA) and excessively long Eustachian valve(EV) or Chiari Network; Complex PFO is the presence of ASA, tunnel length > 8 mm, with Lipomatous hypertrophy of the atrial septum (LHAS), Chiari network and Eustachian valve, multifenestrated ASA, and anatomically distorted PFO [4,5]. The structure of the PFO is similar to that of a valve, since the pressure of the left atrial is higher than that of the right atrium, it is generally closed.…”

Section: Introductionmentioning

confidence: 99%

PFO morphology for evaluation of c-TCD and c-TTE RLS grades

Tian

Chen

2022

Eur J Med Res

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Purpose The purpose of this study was to observe the morphologic characteristics of patent foramen ovale (PFO) by transesophageal echocardiography (TEE), and to analyze its correlation with right-to-left shunt (RLS) of contrast-transthoracic echocardiography (c-TTE) and contrast-transcranial Doppler ultrasonography (c-TCD). Methods 124 patients with PFO were divided into four groups according to the morphological characteristics of PFO. RLS grade of each group PFO with c-TTE and c-TCD in resting and Valsalva manoeuvre was measured. Anatomical structures influencing RLS grade were analyzed statistically through multivariate logistic analyses and predictive models. Results The 124 cases of PFO were divided into four groups: 55 cases (44.4%) with smooth uniform tubular tunnel (SUT), 21 cases (16.9%) with granule uniform tubular tunnel (GUT), 23 cases (18.5%) of right funnelform, 25 cases (20.2%) of left funnelform. Between group comparisons and multivariate logistic analyses revealed that PFO morphotype and interatrial septum(IAS) mobility were influencing factors of RLS degree. During Valsalva, the probability of c-TCD RLS ≥ 2 for the right funnelform PFO was 13.428 times that of the GUT, one unit increase in IAS mobility increased the probability of c-TCD RLS ≥ 2 by a factor of 2.029, model predicted c-TCD RLS ≥ 2 with 78.1% sensitivity and 94.7% specificity; During Valsalva, the probability of c-TCD RLS ≥ 2 for the SUT PFO was 4.244 times that of the GUT, one unit increase in IAS mobility increased the probability of c-TTE RLS ≥ 2 by a factor of 2.392, model predicted c-TTE RLS ≥ 2 with 80.2% sensitivity and 87.9% specificity. Conclusions Studies have shown that the morphological structure of PFO is an influencing factor of RLS, and TEE can observe the specific morphological characteristics of PFO, which can further predict the level of RLS, help predict the occurrence of Cryptogenic stroke (CS). The above provides more evidences and surgical options for Interventional device closure indications.

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“…4 Complex long-tunnel PFOs, defined as having an overlap between the septum primum and the secundum of more than 8 mm, may be more difficult to detect. 5,6 However, long-tunnel PFOs can themselves be a source of stagnated blood and subsequent thrombus development and may place patients at a higher risk of neurological sequelae than simple PFOs. 7,8 We describe a case of a young patient with deep venous thrombosis (DVT), pulmonary emboli (PE), and cardioembolic stroke in the setting of a complex right to left PFO.…”

Section: Introductionmentioning

confidence: 99%

A Case of Complex PFO Leading to Ischemic Stroke

Coles

Haveman-Gould

Farooq

et al. 2015

The Neurohospitalist

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Patent foramen ovale (PFO) has been proposed as a mechanism for cardioembolic stroke, especially in younger patient populations. Complex PFOs, with tunnel lengths exceeding 8 mm, lead to a higher risk of neurological sequelae than simple PFOs and may also be harder to detect with transthoracic echocardiography (TTE). In this article, we present a 29-year-old woman who, after polypharmacy overdose, developed deep venous thrombosis and multiple pulmonary emboli (PE) and subsequent cardioembolic stroke. Initial TTE showed intact interatrial septum with late appearance of agitated saline in the left atrium after the seventh cardiac cycle. Subsequent transesophageal echocardiography, after treatment of PE with an intravenous thrombolytic (alteplase) and anticoagulation with heparin, showed a complex PFO with a 19-mm overlap of the septum primum and secundum without active flow. It is suggested that this PFO allowed for flow only in the situation of elevated right heart strain with PE, causing cardioembolic stroke and detection of agitated saline in the left atrium on TTE. However, under normal physiological situations, which resumed after treatment of PE with alteplase and heparin, the PFO did not allow for flow. This case demonstrates the potential importance of recognition of complex PFOs in diagnosis and management of cardioembolic stroke.

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Influence of PFO Anatomy on Successful Transcatheter Closure

Cited by 5 publications

References 87 publications

Effects of morphological characteristics of patent foramen ovale by transesophageal echocardiography on minimalist transcatheter closure in southern China

Effects of morphological characteristics of patent foramen ovale by transesophageal echocardiography on minimalist transcatheter closure in southern China

PFO morphology for evaluation of c-TCD and c-TTE RLS grades

A Case of Complex PFO Leading to Ischemic Stroke

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