The closure of a patent foramen ovale (PFO) is a catheter-based intervention to prevent PFO-associated stroke. The PFO-occlusion device is advanced through the femoral vein and deployed across the interatrial septum using transesophageal echocardiography (TEE) and fluoroscopic guidance. The following protocol provides a step-by-step guide for the PFO-closure intervention using a double-disc device.
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Method Article
Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
In This Article
Summary
Abstract
A patent foramen ovale (PFO) persists in about one-quarter of people and is the source of up to 25% of all ischemic strokes, especially strokes in young adults. PFO can be easily diagnosed by transthoracic contrast and/or transesophageal echocardiography. Interventional closure of the PFO via the femoral vein is a commonly used cardiological procedure since several trials have demonstrated the superiority of PFO closure over standard medical therapy in patients with PFO and who have experienced post ischemic, cardioembolic, or cryptogenic stroke. The current paper and video show the procedure of PFO closure in a step-by-step manner.
Introduction
The foramen ovale is a remnant from embryologic heart development that usually closes within a few years after birth1. Previously, a patent foramen ovale (PFO) was found in 27.3% of cases in an autopsy study of 965 normal hearts2 and in 25.6% of the 581 subjects in a transesophageal echocardiography (TEE) study3. There are no significant differences with respect to sex or race/ethnicity2,3,4, and autopsy data show that the PFO diameter in adults varies from 1 mm to 19 mm (average: 4.9 mm) and increases wi....
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Protocol
The protocol and video publication were approved by the ethics committee of the University Hospital Jena. The patient gave his agreement for his anonymized data to be published for article purposes.
1. Physiological monitoring
- After bringing the patient to the operating table, establish a peripheral venous access line and connect to 500 cc of NaCl. Fix the arms and legs of the patient.
- Initiate the ECG, peripheral oxygen saturation, and pulse measurements. Perform sterilization of the right groin using an iodine based solution (e.g., Betadine solution).
2. Prepa....
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Results
In this study, the closure of a PFO was successfully performed. The Live echo was able to show the closure of the interatrial septum without residual shunt with the utilized device (see the Table of Materials). The control of the placement of the interatrial septum between the left and the right discs of the device is important to guarantee the stability of the device, and this is checked by TEE in several planes before the release of the device. The device lays smoothly on the interatrial septum without.......
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Discussion
The interventional closure of a PFO is relatively simple compared to other procedures in interventional cardiology. It is important to perform it without complications since patients are mostly young and experience no short-term benefit from the procedure due to its prophylactic nature, in contrast to potentially life-saving therapies during acute myocardial infarction.
The critical steps of the procedure from our perspective are the safe puncture of the groin to avoid bleedin.......
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Disclosures
The video article fees were paid by an unrestricted grant from Occlutec SA. The company had no influence on the article content.
Materials
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| 50 ml syringe- Perfusor syringe Luer-Lock 50 cc | B. Braun | 8728844F | Flush syringe |
| Amplatz Super stiff Guide wire 260 cm | Boston Scientific | M001465021 | exchange wire |
| Amplatzer Sizing ballon II 24 mm | Abbott | 9-SB-024 | sizing |
| catheter set- Angiodyn Set Uni Jena | B. Braun | 6010111-0 | cover set |
| Figulla Flex II PFO Occluder Procedure Pack | Occlutech | 19PFO25DP | various sizes available |
| Mullins Sheat 7-11 fr.- Check Flow Performer Introducer- 9F 75 cm | Cook Medical | RCFW-9.0-38-75-RB-MTS | delivery sheath |
| Multi purpose catheter 5 F - Impulse MPA 1 | Boston scientific | H749163911171 | atrial septal passage |
| Sheath 4 F- Radiofocus Introducer II 4 Fr. 10 cm | Terumo | RS*B40K10MR | arterial blood pressure measurement |
| Sheath 7-11 Fr- Radiofucus Introducer II 9 F 10 cm | Terumo | RS*B90N10MRD | Device Loading |
References
- Moore, K. L., Persaud, T. V. N., Torchia, M. G. The Developing Human: Clinically Oriented Embryology., 10th Edition. , Saunders. Philadelphia. (2015).
- Hagen, P. T., Scholz, D. G., Edwards, W. D. Incidence and size of patent foramen ovale during t....
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