Short-Term Results of Percutaneous Closure of Patent Foramen Ovale Guided By Transoesophageal Echocardiography In Patients With Cryptogenic Stroke: A Retrospective Study

Abstract

Background: Patent foramen ovale (PFO) is a risk factor for cryptogenic stroke (CS), and interventional therapy for PFO can reduce the recurrence rate of CS. However, interventional therapies are primarily guided by X-ray imaging, and data on regular postsurgical follow-up with the transthoracic ultrasound foaming test (UFT) is rare. Thus, this study aimed to assess the short-term (12 months) results of PFO occlusion guided by transoesophageal echocardiography (TEE) and the results of regular UFTs.Methods: Clinical records, echocardiographic data, and UFT results of 75 patients who underwent interventional therapy for PFO and CS were retrospectively analysed. The patients were grouped according to their preoperative UFT results: group A (n=21), small volume of right-to-left shunts; group B (n=22), moderate volume of right-to-left shunts; and group C (n=32), large volume of right-to-left shunts. All patients were treated with an Amplatzer occluder under TEE guidance. UFT follow-up was conducted regularly until 12 months after surgery.Results: No significant differences in preoperative data, length of hospital stay, or operative time were noted between the groups (p>0.05). The length of the PFO and diameter of the occluder differed between the groups as follows: group A=group B<group C (p<0.001). One patient in group C developed recurrent stroke 11 months postoperatively. Two patients in group C developed atrial arrhythmia, which improved after 3 months of antiarrhythmic treatment. However, 19 patients still had positive UFT results 12 months postoperatively. Furthermore, the positive UFT rate 12 months postoperatively differed between the groups as follows: group A=group B<group C (p<0.05). A preoperative large-volume shunt was negatively associated with a negative UFT rate 12 months postoperatively (RR=0.255, p=0.003).Conclusions: In patients with PFO and CS, interventional therapy guided by TEE could lead to satisfactory short-term (12 months) outcomes. Although the positive UFT rate in our study gradually decreased, some patients still had positive UFT results 12 months postoperatively. Preoperatively, a large volume of right-to-left shunts and a longer PFO were two risk factors for positive UFT results postoperatively. Further studies are required to clarify the relationship between positive UFT results postoperatively and stroke recurrence.