1 ▏Introduction
Patent foramen ovale (PFO) is a common abnormality, occurring in
20–34% of the population. Some PFO can open widely, enabling a
paradoxical embolus to transit from the venous to arterial circulation,
which is associated with stroke and systemic embolisation [1]. It
has been implicated in a number of pathologies, such as cryptogenic
stroke (CS), platypnea orthodeoxia syndrome, decompression sickness, and
migraine with auras [2]. Recent trials have shown that closure of
PFO, especially if associated with an atrial septal aneurysm and/or a
large interatrial shunt, may reduce the risk of recurrent stroke as
compared to medical treatment [3, 4]. Percutaneous closure is
conventionally performed under the guidance of fluoroscopy.
Nevertheless, radiation exposure during fluoroscopy represents a risk to
the patient and medical staff. Therefore the development of a safe and
less invasive procedure with less radiation exposure is important, and
transesophageal echocardiography (TEE) was generally used in patients
with clear sound window, transcatheter ASD closure guided by TEE is
proposed [5,6]. Our hospital has carried out TEE-guided percutaneous
PFO closure without fluoroscopy since 2018, we retrospectively reviewed
cases to evaluate the feasibility, safety, and effectiveness of this
approach.