PMC10352606_01
Transesophageal echocardiography. A PFO with a length of 9.7 mm, a diameter of 2.7 mm in the right atrium and 1.1 mm in the left atrium was observed in the middle of the patient's atrial septum. At rest, a moderate amount of shunt was seen in the left atrium, and a large number of shunt was seen immediately after increasing abdominal pressure.
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F1
Transesophageal echocardiography showed normal biventricular function (left ventricular ejection fraction of 65%) and a bidirectional shunt upon saline flush test, indicative of a PFO (severe right-to-left shunt via a PFO 2.7 mm in diameter and 9.7 mm tunnel length during Valsalva maneuver) (Figure 1).
Intraoperative placement of foramen ovale occlusive device. The size of occluder is 18 mm x 25 mm.
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F2
We chose to use an 18 mm x 25 mm occluder for this operation (Figure 2).
Intraoperative holter monitoring. (A) The patient began to show a slow heart rate and ST segment elevation in ll, lll, and avF leads, presenting as a junctional escape rhythm. (B) The patient went into cardiac arrest that lasted 3.8 s. (C) After heartbeat recovery, the patient developed ventricular tachycardia, with a maximum ventricular rate of 240 beats per minute. (D) After rapid chest compressions, electrical defibrillation, intravenous epinephrine (5 mg), sputum aspiration, oxygen inhalation, and fluid replenishment, the patient returned to sinus rhythm.
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F3
PFO was successfully performed (Figure 3). Post-operative echocardiography showed that the shape and position of the occluder were normal and there was no significant residual shunt.