The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Suture-Mediated Percutaneous Patent Foramen Ovale Closure:  A Systematic Transesophageal Echocardiography Study

DOI: 10.4244/EIJ-D-21-00242

1. Scientific Institute San Raffaele: IRCCS Ospedale San Raffaele, Interventional Cardiology Unit, Milano, ITALY
2. Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
3. Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

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Percutaneous patent foramen ovale (PFO) closure has been proven superior over medical therapy for secondary prevention in selected patients with cryptogenic stroke.[1] Furthermore, percutaneous PFO closure prevents decompression sickness and platypnea-orthodeoxia syndrome, and might play a role in patients with migraine.[2]However, despite their recognized efficacy, PFO occluders carry a potential risk of early and late complications and might represent an obstacle for future trans-septal left-sided catheter-based interventions.[3] As the vast majority of PFO closure interventions are carried out for preventive purposes in the young population, the concept of “deviceless” PFO closure became increasingly attractive and has been tested for over a decade, however with poor results.[3] Recently, a suture-mediated approach to percutaneous PFO closure has been proposed. Early data demonstrated feasibility in different anatomical conditions, with high device success rate and no device-related complications.[4,5] Nevertheless, post-procedural PFO patency and device-related complications at follow-up have been only assessed using transthoracic echocardiography (TTE) microbubbles test, which provides limited sensitivity, rising uncertainties regarding actual device performance.[6,7] Therefore, we conducted the present study to evaluate the efficacy and safety of suture-mediated PFO closure by transesophageal echocardiography (TEE), which has been shown to have higher sensitivity than TTE for detection of residual shunt and characterization of device-related complications.[1]

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