Occlusion by catheter intervention in patent foramen ovale via additional transseptal puncture

In patients with a cryptogenic cerebral ischemia, the percutaneous closure of a patent foramen ovale (PFO) has gained increasing acceptance as an alternative strategy to prevent paradoxical embolism. Promising data with low recurrence rates have been reported for several self-expanding double disk devices. The implantation of the device is usually performed by passing the PFO. However, in one patient with a TIA (m, 43 years) transesophageal echocardiography (TEE) revealed an atrial septum abnormality with a hypermobile septum and a very small distance (approximately 12 mm) between the PFO channel and the anterior mitral valve leaflet, which was too short to accommodate the regular implantation procedure of the device via the PFO-channel itself. In this particular case the device (PFO-Star TSD) was advanced to the left atrium via an additional transseptal puncture--performed under TEE guidance--to allow for complete closure of the PFO without impairment of the mitral valve function. No periinterventional complications were observed. During the follow-up period of 9 months the patient was completely asymptomatic with no functional impairment of the mitral valve and no residual intracardiac shunt.