Three-dimensional imaging of the atrial septum and patent foramen ovale anatomy: Defining the morphological phenotypes of patent foramen ovale

Abstract

Patent foramen ovale (PFO) is known to occur with greater prevalence in those with cryptogenic stroke. These observations support the role of a PFO as a channel for paradoxical embolism and a mechanism for cerebral ischaemic events. Transcatheter closure of PFO may be indicated in this setting. A prerequisite of procedural success is achieving complete closure of the shunt. Studies have shown a varying degree of successful shunt closure. Residual shunts are usually the result of a mismatch between the device shape and PFO anatomy. In this article, we review the features of PFO and their surrounding structures as seen by three-dimensional transoesophageal echocardiography in patients undergoing transcatheter closure and relate these to the variations in morphology on anatomical specimens for a better appreciation of their suitability for closure devices. The salient features of the anatomical variations seen in adults undergoing transcatheter device closure have been summarized and used to produce a practical pre-procedural checklist. © 2010 The Author.