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.