Comparison of fluoroscopy and intracardiac echocardiography for control of endovascular closure of patent foramen ovale

Objective. To compare the results of endovascular closure of patent foramen ovale (PFO) under fluoroscopy and intracardiac echocardiography (ICE). Material and methods. The study included 212 patients who underwent endovascular closure of PFO between 2019 and 2023. The subjects were divided into two groups: fluoroscopy (FS) in 183 patients and ICE in 29 patients. Clinical status of patients was analyzed for 12 months. We estimated technical features of surgery, complications, efficacy of procedure and recurrent adverse events. Results. Surgery time in the ICE group was 40.00 [30.00; 60.00] min, and patients were not exposed to radiation. The occluder was placed in optimal position in all patients. In the FS group, surgery time was 60.00 [45.00; 75.00] min (p=0.0067), radiation time and dose — 612.00 [381.00; 952.50] sec and 9.30 [6.52; 15.12] mSv, respectively. The most serious complications in the FS group were supraventricular tachycardia in 9 (4.92%), mitral valve contact in 1 (0.55%), hemopericardium in 2 (1.09%), and TIA in 1 (0.55%) patient. The length of hospital-stay was 7.00 [4.00; 8.00] days. In the ICE group, we observed vein thrombosis in 1 (3.45%) and body temperature elevation >an 37.1°C in 2 (6.90%) cases. The length of hospital-stay was 5.00 [3.00; 6.00] days (p=0.0016). After 12 months, TIA and ischemic stroke occurred in 2 (0.58%) patients of the FS group, respectively. No vascular catastrophes were recorded in the ICE group. Conclusion. ICE-guided endovascular closure of PFO demonstrated better efficacy and safety.