Impact of Patent Foramen Ovale Anatomical Complexity on Fluoroscopy Time During Transcatheter Closure.

Background: Complex patent foramen ovale (PFO) anatomical features can increase procedural difficulty during transcatheter closure, often leading to prolonged fluoroscopy time. Aim: This study aimed to evaluate the relationship between PFO anatomy, assessed via transesophageal echocardiography (TEE), and prolonged fluoroscopy time during transcatheter closure. Methods: This retrospective study analyzed 83 patients (median age: 45 years, 58% male) undergoing PFO closure for cryptogenic stroke. TEE measurements included key anatomical parameters related to PFO morphology and shunting dynamics. Patients were categorized into prolonged (≥ 80th percentile) and standard (< 80th percentile) fluoroscopy-time groups. Logistic regression, Pearson correlation analysis, and receiver operating characteristic (ROC) curve analyses were used to identify predictors of prolonged fluoroscopy time. Results: The prolonged fluoroscopy-time group had a significantly longer tunnel length (17.5 mm [interquartile range (IQR): 14.25-20.75] vs. 12.0 mm [IQR: 8.00-14.00], p < 0.01) and smaller aortic rim (3.0 mm [IQR: 2.0-3.75] vs. 6.0 mm [IQR: 5.0-8.0], p < 0.01). Fluoroscopy time correlated positively with tunnel length (r = 0.72, p < 0.001) and negatively with aortic rim length (r = -0.65, p < 0.001). Logistic regression identified tunnel length (odds ratio [OR] = 1.459; 95% confidence interval [CI]: 1.190-1.789) and aortic rim length (OR = 0.537; 95% CI: 0.378-0.764) as independent predictors. ROC curve analysis revealed a cut-off of 12.5 mm (area under the curve [AUC] = 0.770) for tunnel length and 5.5 mm (AUC = 0.798) for aortic rim in predicting prolonged fluoroscopy time. Conclusions: The findings of this study suggest that complex PFO anatomical features significantly impact fluoroscopy time, underscoring the need for detailed pre-procedural TEE assessments to optimize procedural planning and outcomes.