A new echocardiographic index to select patients for PFO suture‐mediated percutaneous closure

Abstract

AbstractObjectivesTo identify a simple echocardiographic predictor of procedural success to select patient for percutaneous suture‐mediated patent fossa ovalis (PFO) closure.BackgroundPercutaneous suture‐mediated PFO closure has been shown as a safe and advantageous alternative to device‐based PFO closure, yet its overall success is slightly lower in unselected patients.MethodsPreprocedural transesophageal echocardiogram (TEE) of 302 patients (113 men, 45 ± 12 years) who underwent percutaneous suture‐mediated PFO closure were reviewed.ResultsAt echocardiographic follow‐up (3–6 months), residual right‐to‐left shunt (RLS) ≥2 was found in 60 (19.9%) patients. At multivariable analysis, only two anatomical variables measured at preprocedural TEE were found as independent predictors of residual RLS ≥ 2 at follow‐up: PFO maximum width (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.16–3.40, p = 0.02) and PFO minimal septa overlapping (OR 0.58, 95% CI 0.35–0.88, p = 0.02). An index based on the ratio of PFO maximum width to PFO minimum septal overlapping (W/SO) proved to be the most powerful predictor of RLS ≥ 2 at follow‐up (OR 48.1, 95% CI 9.3–352.2, p < 0.01). The ROC curve for the W/SO ratio was found to have an AUC of 0.84 (95% CI 0.75–0.93) and a cut‐off value of 0.61 yielding a sensitivity of 80% and specificity of 78% with a negative predictive value of 94%. A decision tree methodology's AUC was 0.75 (95% CI 0.67–0.83).ConclusionsThe results of this study indicate that the ratio between the maximum amplitude of the PFO and the minimum overlap of the septa is the best predictive index of a favorable result by using one stitch only.