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Background Patent foramen ovale (PFO) closure is a common procedure in patients with prior cryptogenic strokes, often guided by fluoroscopy. In this often young population of productive age, radiation dosage can be a important factor. While existing studies generally report low radiation doses, occasional instances of higher doses have been noted. Purpose This retrospective audit aims to evaluate the fluoroscopy time, radiation dosage, efficacy, and safety of PFO closure procedures at a regional tertiary hospital in Northwest England. Methods Retrospective data of patients undergoing PFO closure between February 2015 and November 2021 were collected from electronic databases. Patients meeting referral criteria during this period were included and analysed. Procedural details, radiation exposure, complications and follow-up outcomes were evaluated. Results Out of 168 referred patients, 91 (54.2%) met inclusion criteria and underwent PFO closure. The average age was 45 years (range 18–60), with 53% being male. Cryptogenic stroke was the primary indication in 96% of cases. Successful closure, guided by intracardiac echocardiography (ICE) and fluoroscopy, was achieved in 96% of patients. Failed procedures (4%) were attributed to multiple fenestration (1%) and uncrossable PFO (3%) The average procedural time was 50 minutes (Range 30–70 mins), fluoroscopy time was 6 minutes (range 2- 30 minutes) and average Dap was 854.5 (71.4–4949) cGy x cm2 , equivalent to 1.37 (0.11–7.92) mSv . There were no immediate periprocedural complications. Late procedural complications included 2% of patients developing atrial fibrillation. 95% of patients had same-day discharge. Six months post-procedural bubble echocardiogram showed successful closure of PFO in 96% of patients. Conclusion This retrospective observational audit data demonstrated PFO closure under intracardiac echocardiography guidance is a safe and effective procedure associated with low radiation dosage and peri-procedural complications. However, isolated high doses cases were identified, high-lightening the importance of strategies to minimize radiation exposure, such as the use of low-dose fluoroscopy techniques. Unfortunately, this is a single-centre experience and may not be able to generalise to the general PFO closure practice in the whole United Kingdom. Conflict of Interest none
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