A New Method for Patent Foramen Ovale Closure: Delivering Sheath Over Coronary Sinus Catheter into Left Atrium
A 34-year-old female with cryptogenic stroke was admitted to our hospital. On a physical examination, she had left paraplegia. Her electrocardiography was in sinus rhythm. Transthoracic echocardiography was normal, except interatrial septal aneurysm. Thus, transeosaphageal echocardiography was performed, which revealed interatrial septal aneurysm and PFO (). Hence, percutaneous closure of PFO, under general anesthesia with the guidance of transesophageal echocardiography (TEE), was planned. A 7 Fr sheath was introduced through the right femoral vein, and 80 U/kg of unfractioned heparin was administered, intravenously. PFO was attempted to cross unsuccessfully with multipurpose, right Judkins, and right Amplatz diagnostic catheters. After a right atrium angiography, we crossed PFO with coronary sinus catheter to assess the reference entry point, and then another 7 Fr catheter was inserted to the left femoral vein and tried to cross PFO with Multipurpose, right Judkins and Amplatz diagnostic catheters over normal and hydrophilic guide wires under the guidance of coronary sinus catheter, but could not passed through PFO. Thus, we pulled the catheters and inserted 9 Fr delivery sheath from the left femoral vein, then inserted 7 Fr coronary sinus catheter through the delivery sheath and crossed PFO with coronary sinus catheter ( and ), and deployed the delivery sheath over coronary sinus catheter into the left atrium, and pulled back the coronary sinus catheter and inserted the Amplatzer PFO occluder through the delivery sheath, successfully deploying the occluder ( and ). The patient was discharged uneventfully with aspirin 100 mg and clopidogrel 75 mg per/day medication.