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Background <p>Closure of a patent foramen ovale (PFO) is an effective strategy in the prevention of recurrent stroke after cryptogenic stroke. Residual shunt (RS) is a common issue following PFO closure and may affect safety and efficacy. Transesophageal echocardiography (TEE) is the key diagnostic tool, but standardized assessment of morphological parameters to prevent RS remains challenging.</p> Aims <p>In this study, we investigate the diagnostic value of different anatomical parameters assessed by TEE to predict RS after PFO closure.</p> Methods <p>We consecutively enrolled five-hundred and twenty-seven (<i>n</i> = 527) patients undergoing PFO closure. We performed pre-interventional TEE, and after PFO closure, we then screened for RS by TEE at 6-month follow-up.</p> Results <p>Pre-interventional TEE measures of PFO morphology revealed significant differences in patients with RS in comparison to those with closed PFO. Incidence of RS was significantly more frequent in patients with atrial septum aneurysm (<i>p</i> = 0.022) and increasing PFO size (<i>p</i> = 0.025). In patients with RS, we found significantly increased length (<i>p</i> = 0.005) of septum primum and PFO tunnel (<i>p</i> = 0.036) as well as excursion (<i>p</i> = 0.005) of septum primum. By training machine learning models on TEE parameters, stratification of PFO morphology resulted in high diagnostic accuracy to predict RS after PFO closure.</p> Conclusions <p>Our study elucidates that a baseline characterization of PFO morphology using TEE improves diagnostic precision to identify patients with RS after PFO closure. A standardized approach might thus enhance the efficacy and safety of transcatheter PFO closure. Prediction of complete closure might reduce complications and allow for a more refined patient selection and treatment.</p> Graphical Abstract <p>Prediction of peri-device leak in patients PFO and paradoxical embolism undergoing percutaneous PFO closure. Workflow of this study investigating the association of morphological determinants with an increased incidence of residual shunting assessed through transesophageal echocardiography.</p> <p></p>

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Pre-interventional transesophageal echocardiography as a reliable predictor of residual shunt following patent foramen ovale closure

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月24日

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  • Tobias Harm,
  • Monika Zdanyte,
  • Andreas Goldschmied,
  • Álvaro Petersen Uribe,
  • Marc Reinert,
  • Juergen Schreieck,
  • Parwez Aidery,
  • Dominik Rath,
  • Tobias Geisler,
  • Meinrad Paul Gawaz,
  • Michal Droppa

摘要

Background

Closure of a patent foramen ovale (PFO) is an effective strategy in the prevention of recurrent stroke after cryptogenic stroke. Residual shunt (RS) is a common issue following PFO closure and may affect safety and efficacy. Transesophageal echocardiography (TEE) is the key diagnostic tool, but standardized assessment of morphological parameters to prevent RS remains challenging.

Aims

In this study, we investigate the diagnostic value of different anatomical parameters assessed by TEE to predict RS after PFO closure.

Methods

We consecutively enrolled five-hundred and twenty-seven (n = 527) patients undergoing PFO closure. We performed pre-interventional TEE, and after PFO closure, we then screened for RS by TEE at 6-month follow-up.

Results

Pre-interventional TEE measures of PFO morphology revealed significant differences in patients with RS in comparison to those with closed PFO. Incidence of RS was significantly more frequent in patients with atrial septum aneurysm (p = 0.022) and increasing PFO size (p = 0.025). In patients with RS, we found significantly increased length (p = 0.005) of septum primum and PFO tunnel (p = 0.036) as well as excursion (p = 0.005) of septum primum. By training machine learning models on TEE parameters, stratification of PFO morphology resulted in high diagnostic accuracy to predict RS after PFO closure.

Conclusions

Our study elucidates that a baseline characterization of PFO morphology using TEE improves diagnostic precision to identify patients with RS after PFO closure. A standardized approach might thus enhance the efficacy and safety of transcatheter PFO closure. Prediction of complete closure might reduce complications and allow for a more refined patient selection and treatment.

Graphical Abstract

Prediction of peri-device leak in patients PFO and paradoxical embolism undergoing percutaneous PFO closure. Workflow of this study investigating the association of morphological determinants with an increased incidence of residual shunting assessed through transesophageal echocardiography.