Patent Foramen Ovale Embryology, Anatomy, and Physiology

A thorough understanding of the interatrial septal anatomy along with its assessment by different imaging modalities is critical in performing safe trans- catheter PFO closure. PFO closures should be a low-risk procedure and is facilitated with TEE or ICE guidance, although there are operators who only use fluoroscopy with the Amplatzer device. The authors suggest performing a TEE prior to closure procedures to better appreciate the septal anatomy and to anticipate and rule out variables such as a small PFO or a long tunnel PFO, sinus venous ASD, pulmonary arterial-venous malformations, or unusual septal structures. This is complemented with intraoperative imaging, including a full ICE interrogation of the interatrial septum and agitated saline contrast study at the beginning of the procedure.