Impact of Transesophageal Echocardiographic Parameters on Procedure-Related Radiation Exposure in Percutaneous Transcatheter Patent Foramen Ovale Closure

Abstract Background: Patent foramen ovale (PFO) is a cardiac congenital anomaly with a prevalence of 20% to 30% in the general population, associated with clinical conditions such as cryptogenic stroke, migraine, and decompression sickness. Percutaneous PFO closure has been proven superior to medical treatment alone for PFO-related stroke, exhibiting a favorable safety profile. However, the procedure's radiation exposure necessitates a deeper understanding of the influencing factors, especially the impact of PFO anatomical characteristics on radiation dose and procedural time. Methods: This study analyzed 83 patients undergoing transcatheter PFO closure for CS. The study evaluated the relationship between the anatomical features of PFO and radiation exposure, measured by Air Kerma. Increased radiation exposure was defined as falling within the highest quintile (5 th quantile) of the Air Kerma. Statistical analyses included univariate and multivariate logistic regression and Receiver Operating Characteristic (ROC) analysis. Results: The study population had a mean age of 40.9 ± 9.0 years, with a slight male predominance (51.8%). The median fluoroscopy time was 10.9 minutes, with an interquartile range (IQR) of 7.5 to 19.9 minutes. The median Air Kerma value was 149 mGy (IQR, 83 – 311). In the multivariate regression analysis, a shorter aortic rim length was identified as an independent predictor of increased radiation exposure, with an odds ratio of 2.01 (95% confidence interval CI, 1.3 – 3.1; P=0.002). In the ROC analysis, the aortic rim length demonstrated good predictive value for increased radiation exposure, with an area under the curve of 0.872 (95% CI, 0.791 – 0.953; P<0.001). A cutoff value of less than 4.5 mm for the aortic rim length was associated with an 88% sensitivity and 80% specificity in predicting increased radiation exposure. Conclusion: A short aortic rim length is associated with increased radiation exposure during percutaneous closure of PFO.