Abstract 752: Added Value of Real-time Three-dimensional Transoesophageal Echocardiography in Percutaneous Closure of the Patent Foramen Ovale
Background: Percutaneous closure of the patent foramen ovale is nowadays a commonly perfomed technique. This procedure is usually monitored by fluoroscopy, and mostly by two-dimensional (2D) transoesophageal echocardiography (TEE). A wide array of PFO anatomies exists. However, visualization of the interatrial septum and the surrounding environment is limited due to only two spatial dimensions when using 2D TEE. The choice of type and dimension of the closure device(s) used, is crucial for subsequent successful PFO closure. Therefore we aimed to assess the added value of real-time three-dimensional (3T 3D) TEE for the guidance of percutaneous PFO closure.
Methods: Fluoroscopy, 2D TEE and 3D RT TEE were performed during percutaneous closure of PFO in patients referred for prevention of paradoxical embolism.
Results: Fourty-two consecutive patients were included. In all patients RT 3D TEE was feasible and provided images of sufficient quality for guidance of percutaneous PFO closure. RT 3D TEE provided an accurate anatomical visualization of the interatrial septum and the size and shape of the defect. In 8 patients with tunnelized PFO, RT 3D TEE guidance avoided placement of more than 1 device as compared to 2D TEE alone. The choice of the appropriate size of closure device was tailored using RT 3D TEE. In 4 patients multiple defects were visualized and in each case, closure of the defects with one device was possible. RT 3D TEE allowed guiding the catheter through the central opening, in relation to adjacent cardiac structures such as the coronary sinus and the mitral, tricuspid and aortic valves. At 6 months residual patency was present in 5 patients (12%).
Conclusion: In conclusion, RT 3D TEE during percutaneous PFO closure is safe and improves visualization of the shape, size and the number of defects, leading to optimal selection and positioning of the closure device.