Percutaneous Closure of Patent Foramen Ovale: Expert Opinion and Proposed Framework on Procedural Aspects and Imaging Techniques

Transcatheter closure of the patent foramen ovale (PFO) is an established therapy for patients who have had a cryptogenic stroke in the presence of a PFO. However, limited guidance is available to support a consistent and standardized approach regarding imaging during the intervention and during follow‐up and management of patients who underwent PFO closure. The present expert opinion was developed by European clinical experts experienced in transcatheter PFO closure, based on the experts’ clinical experience and available clinical evidence. The primary aim is to propose a framework providing guidance for the use of imaging prior to and during the intervention, as well as during follow‐up. Aspects addressed include exploration of the relevant anatomy and identification of anatomical risk factors, device sizing, prevention and management of residual shunting, endocarditis, and new‐onset atrial fibrillation, and the use of nickel‐containing devices. Additional aspects related to maintaining a high quality of care are addressed.