Closure of Patent Foramen Ovale

A 52-year-old woman had a closure of a patent foramen ovale (PFO) with a 30-mm Helex septal occluder (W. L. Gore & Associates, Flagstaff, Arizona) after a left hemispheric stroke and recurrent transient ischemic attacks (TIAs).

She reported no further TIAs after the implantation.

At a 6-month follow-up transesophageal echocardiogram (TEE) after PFO closure, Figures 32-1, 32-2 and 32-3 and Videos 32-1 to 32-3 were obtained to confirm device position.

Figure 32-1. A. 2D TEE 45°. B. 3D TEE full-volume acquisition.

Figure 32-2. 2D TEE: X-plane (60° and 150°) with color Doppler.

Figure 32-3. A. 2D TEE: Long-axis (LAX) view (112°) contrast study: Administration of agitated saline via a cubital vein. B. 3D TEE enface view from the left atrial (LA) side.

QUESTION 1. Based on Figures 32-1, 32-2 and 32-3 and Videos 32-1 to 32-3, what is your diagnosis?

A. The septum secundum is sealed adequately by the left and right atrial discs of the Helex septal occluder

B. No complications after device implantation can be detected

C. A complication after device closure can be verified

D. A residual shunt can be detected

View Answer

ANSWER 1: C. The images (Fig. 32-1 and Video 32-1) demonstrate that the septum secundum is not adequately sealed by the left and right atrial discs; a gap is seen along the septum secundum. The color flow (Fig. 32-2 and Video 32-2) clearly documents a residual shunt in this region, which has to be considered a complication.