Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Abstract

Background: Percutaneous closure of patent foramen ovale (PFO) is routinely performed using plain fluoroscopy in the catheter room. This method results in inevitable radiation damage, adverse effects of contrast agents on kidneys, and high cost. We performed PFO closure with a simplified and economical transesophageal echocardiography (TEE)-only guided approach in the operating room. This study aimed to investigate the feasibility, safety, and effectiveness of the percutaneous closure of PFO by only using TEE. Methods: We reviewed the medical records of patients who underwent percutaneous PFO closure at our center from December 2013 to December 2017. A total of 132 patients with PFO and cryptogenic strokes underwent PFO closure by using cardi-O-fix PFO device under TEE guidance. The participants comprised 64 and 68 male and female patients, respectively. The mean age and body weight of the patients were 39.40 ± 13.22 years old (12-68 years old) and 65.42 ± 9.70 kg (40-95 kg), respectively. All patients only received aspirin (3-5 mg/kg body weight, oral administration) for 6 months. Contrast-enhanced transthoracic echocardiography (c-TTE) with Valsalva maneuver was performed during follow-up, and questionnaire surveys were obtained at 3, 6, and 12 months after the procedure. Results: All (100%) patients were successfully closed. Follow-ups were conducted for 13 months to 48 months, with an average of 27 months. No severe complications were found during the follow-up period. Paroxysmal atrial fibrillation occurred in 4 patients within 3 months after the procedure. No recurrent stroke or death occurred in all patients during the follow-up period. Transient ischemic attack occurred in one patient 6 months after the procedure. Ten (7.6%) patients had a right-to-left shunt, as demonstrated by c-TTE at 12 months of follow-up. Among the 57 patients suffering from migraine, significant relief or resolution was reported by 42 (73.7%) patients. Conclusion: TEE-only guided PFO closure was a safe, feasible, and effective method that did not require the use of X-rays and contrast agents.

Short-Term Results of Percutaneous Closure of Patent Foramen Ovale Guided by Transoesophageal Echocardiography in Patients with Cryptogenic Stroke: A Retrospective Study

“…These results suggest that PFO interventional therapy under TEE guidance is safe. Compared to traditional X-ray-guided surgery, TEE-guided surgery provides clearer surgical images, avoids the use of contrast agents, and avoids exposure to X-rays [16,17]. 2) The most common complications after PFO interventional therapy are recurrent stroke and atrial brillation [18,19]; however, in this study, no cases of recurrent stroke occurred within 1 year after surgery, and only two patients developed atrial arrhythmias (alternating atrial brillation and atrial utter) 3 months postoperatively, which improved after 3 months of amiodarone (200 mg/d) therapy.…”

The research of the relationships between patent foramen ovale and ischemic stroke in elderly patients

“…That is, when the right heart pressure increases, such as pulmonary hypertension, cough, Valsalva action, the venous system or right heart embolism enters the systemic circulation, resulting in the abnormal right-to-left shunt channel formed by PFO, resulting in the occurrence of ischemic stroke. Some studies proposed that the diagnostic criteria for abnormal embolism include deep vein thrombosis and pulmonary embolism, there is an abnormal channel between the left and right hearts, and there is a pressure gradient from right to left shunt in the heart, with imaging or pathology [23,24] . However, it has been found in clinical work that only a few patients with PFO-related ischemic stroke can nd venous thrombosis.…”

Manual zur Indikation und Durchführung spezieller echokardiographischer Anwendungen

“…Aufgrund vieler Spezifikationen erfordert das echokardiographische Monitoring von Katheterinterventionen mittels TEE eine gezielte und intensive Ausbildung [ 42 ]. Die Qualität der Bildgebung bei der Intervention entscheidet oft über die Minimierung von möglichen Komplikationen und den Behandlungserfolg.…”

“…Das TEE-Monitoring beim Verschluss des offenen Foramen ovale (PFO) bestimmt die Auswahl des Devices und seiner Größe im Hinblick auf die Morphologie des PFO und des interatrialen Septums (Abb. 10 ; [ 41 , 42 , 94 , 95 ]). Das Prinzip des interventionellen PFO-Verschlusses basiert darauf, den PFO-Kanal der ausgebliebenen Fusion von Septum primum und secundum über einen Doppelschirm mit mittlerem Steg zu verschließen.…”