Evaluation Of Morphological Characteristics Of Patent Foramen Ovale By Transesophageal Echocardiography And Its Clinical Significance In Inteention Closure

ObjectiveThe patent foramen ovale(PFO)acts as a channel for paradoxical embolism(PE)and is therefore associated with a variety of diseases,PFO present in 20%-35%of the adults.Transesophageal Echocardiography(TEE)is the "gold standard" and preferred choice of the all methods for diagnosing PFO.In this study,the size,shape and the surrounding structures of the PFO were observed by TEE.And their morphological features were statistically classified.Combined with the time of interventional closure of PFO,we evaluated the characteristics of PFO and effects of morphological classification on the difficulty of closure to analyse the significance of TEE in interventional occluding therapy in patients with PFO.MethodsAll the subjects were from the First Affiliated Hospital of Soochow University from April 2016 to January 2019 who considered as PFO in the department of neurology.A total of 58 patients were examined with cTTE and TEE.We observed and recorded the location,size and length of PFO,the thickness of primary septum and secondary septum,the structure of complicated defect and surrounding structure.Their morphological features were statistically classified.There were up to 30 cases of PFO received transcatheter closure,of which 28 cases were within the scope of the above study.All patients were from the department of cardiology of the First Affiliated Hospital of Soochow University.The time of operation(from the beginning of the angiography to the removal of the sheath)were recorded.According to the morphological characteristics of PFO,we tried to find a new parameter,which can reflect the difficulty of PFO intervention.The relationship between the new parameter and the operation time was studied.ResultsIn 51 cases of cTTE combined with TEE,PFO with right funnel were 18 cases,non-right funnel were 32 cases(Left funnel 2 cases and tubular 30 cases),only 1 patients concurrent with atrial septal aneurysm(ASA).Twelve cases with right funnel and 32 with Non-right funnel(Left funnel 1 case and Tubular 14 cases)in 27 cases were successfully closed.In the interventional closure of PFO,the time of right funnel PFO was significantly shorter than that of non-right funnel(25±2.78 vs 40±5.50,P=0.028).There was no significant difference among the characteristics of PFO,including enter diameter,exit diameter,middle diameter,the thickness of secondary septumd and primary septum and length of PFO.PFO closure difficult coefficient=PFO length/(enter÷exit)× N.There was a strong linear correlation between the PFO closure difficult coefficient and the operational time.According to the limit of the upper third quartile of the operational time,patients was divided into two groups:group≥ 40min and group<40min.The group of operation time≥40min BMI is bigger and heart rate is slower,the PFO closure difficult coefficient is bigger.ROC curve showed the sensitivity and specificity of the PFO closure difficult coefficient to predict the operational time≥40min were 66.7%and 83.3%,respectively.Logistic univariate regression analysis showed that PFO closure difficult coefficient related to the time of operation(P=0.021).ConclusionsTEE plays an important and significant role to classify morphological characteristics of PFO and to the guidance of interventional occluding surgery.Our self-created PFO occlusion difficult coefficient could predict the degree of difficulty of interventional occlusion.