Intracardiac echocardiography-guided transseptal PFO closure with Swartz SL1 Sheath: A safe and feasible approach for complex cases

Transcatheter closure of patent foramen ovale (PFO) has emerged as an effective therapeutic strategy, demonstrating superiority over medical treatment for patients with cryptogenic stroke (CS) or transient ischemic attack (TIA). This study aimed to evaluate the safety and feasibility of using intracardiac echocardiography (ICE) combined with the Swartz SL1 transseptal sheath for transcatheter PFO closure. This single-center study included consecutive patients with complex PFO, combined CS/TIA, and moderate to high levels of right-to-left shunt (RLS). Initial attempts to traverse the PFO were made using conventional methods; however, for cases where these attempts were unsuccessful, the PFO was subsequently traversed using the Swartz SL1 sheath under ICE and fluoroscopy guidance as a rescue strategy. Eighteen patients were enrolled, and the PFO was traversed using the Swartz SL1 sheath under ICE and fluoroscopy guidance. All procedures were performed under local anesthesia. The time required to traverse the PFO, total procedural duration, fluoroscopy time, and radiation dose were recorded. The mean time to traverse the interatrial septum was 1.62 [1.28–2.03] min, with a fluoroscopy duration of 0.97 [0.72–1.28] s. The total fluoroscopy duration and dose were 4.05 [3.16–6.53] min and 154.7 [57.0–280.0] mGy, respectively. The mean procedural duration was 28.3 ± 6.1 min. The combination of ICE and the Swartz SL1 transseptal sheath is a safe and efficient approach for transcatheter PFO closure, significantly reducing procedural time and radiation exposure compared to conventional methods, thereby enhancing safety. This approach may represent a safer and more efficient alternative to conventional methods, particularly in patients with complex PFO anatomy.