PMC9163404_01
TEE showed a PFO with an ASA (A) and a small amount of left-to-right shunt through the fossa ovale (B).
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F1
ASA (Figure 1). After multidisciplinary diagnosis, transcatheter PFO closure is recommended.
cTTE showed substantial RLS at rest (A) and Valsalva maneuver (B).
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F2
TTE examination showed a PFO with an ASA, and contrast transthoracic echocardiography (cTTE) showed substantial right-to-left shunting (RLS) at rest and Valsalva maneuver (Figure 2). The CT examination of the lower extremity veins showed implantation of the inferior vena cava filter, inferior vena cava and bilateral external iliac vein thrombosis, and bilateral internal iliac vein thrombosis (Figure 3).
The CT examination of the lower extremity veins showed implantation of the inferior vena cava filter, inferior vena cava and bilateral external iliac vein thrombosis, and bilateral internal iliac vein thrombosis.
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F3
TTE examination showed a PFO with an ASA, and contrast transthoracic echocardiography (cTTE) showed substantial right-to-left shunting (RLS) at rest and Valsalva maneuver (Figure 2). The CT examination of the lower extremity veins showed implantation of the inferior vena cava filter, inferior vena cava and bilateral external iliac vein thrombosis, and bilateral internal iliac vein thrombosis (Figure 3).
Transcatheter PFO closure procedure. (A,B) The guidwire reached the left superior pulmonary vein through the PFO; (C,D) The ordinary guidewire could not provide sufficient support, and a 180 cm 0.025" stainless steel guidewire with coiled floppy tip was exchanged to provide sufficient support; (E) X-ray showed good position before the occluder was released; (F) X-ray showed good position after the occluder was released.
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F4
AL catheter, Cordis 6Fr JR4 catheter), and probing with a straight 0.035 inch guidewire was unsuccessful. A Medtronic LAUNCHER 6Fr EBU 3.5 mm guiding catheter was then advanced to the right atrium, initially positioned below the atrial septum at the level of the tricuspid valve, and then withdrawn superiorly, allowing it to engage and pass through the PFO into the left atrium and left superior pulmonary vein (Figures 4A,B). Due to insufficient support, when the guiding catheter was passed through the PFO, the guiding catheter and guidewire were slid into the inferior vena cava simultaneously (Figure 4C). The guiding catheter passed through the PFO smoothly and the stainless steel guidewire was looped into the left atrium (Figure 4D). Jude Medical, Golden Valley, MN) was successfully deployed with good apposition as assessed by fluoroscopy and TTE (Figures 4E,F).