Yan Rui, Li Xiaofang, Li Jun, Shao Xin, Zhang Anxin, Guo Liping, Li Fanqi, Wang Haixiong
Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China.
Department of Digestive Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Front Cardiovasc Med. 2025 Jul 23;12:1623207. doi: 10.3389/fcvm.2025.1623207. eCollection 2025.
While transcatheter closure of a patent foramen ovale (PFO) is usually technically feasible, certain anatomical subtypes such as long-tunnel PFOs can present considerable challenges. Due to the difficulty in advancing the guidewire through the elongated and tortuous tunnel, interventional cardiologists often have to resort to transseptal puncture. However, transseptal puncture is associated with a higher incidence of postoperative residual shunts and an increased risk of puncture-related complications. In this case report, we describe for the first time a novel approach that combines intracardiac echocardiography (ICE) with a pressure-sensing catheter to facilitate guidewire advancement during the PFO procedure. We refer to this innovative technique as the "push and easy" method. This approach offers a promising solution for the closure of complex long-tunnel PFOs while minimizing radiation exposure during the procedure.
A 20-year-old male patient with a complex long-tunnel PFO was referred to our center. Initial attempts to visualize and traverse the PFO using ICE alone were unsuccessful due to the tunnel's excessive length and tortuosity. Consequently, a pressure-sensing catheter was introduced. This catheter, offering real-time pressure feedback along with enhanced support and maneuverability, enabled successful guidewire passage through the PFO. Under the combined guidance of ICE and the pressure-sensing catheter, precise and safe closure of the complex PFO was achieved, without any radiation exposure. We refer to this novel, radiation-free approach as the "push and easy" technique, which may offer a valuable option for the management of complex long-tunnel PFOs.
虽然经导管闭合卵圆孔未闭（PFO）在技术上通常是可行的，但某些解剖亚型，如长隧道型PFO，可能带来相当大的挑战。由于导丝难以穿过细长且迂曲的隧道，介入心脏病学家常常不得不采用经房间隔穿刺。然而，经房间隔穿刺与术后残余分流的发生率较高以及穿刺相关并发症的风险增加有关。在本病例报告中，我们首次描述了一种将心腔内超声心动图（ICE）与压力传感导管相结合的新方法，以在PFO手术过程中促进导丝推进。我们将这种创新技术称为“推即通”方法。这种方法为闭合复杂的长隧道型PFO提供了一个有前景的解决方案，同时在手术过程中尽量减少辐射暴露。
一名患有复杂长隧道型PFO的20岁男性患者被转诊至我们中心。最初仅使用ICE可视化并穿过PFO的尝试因隧道过长且迂曲而未成功。因此，引入了一根压力传感导管。该导管可提供实时压力反馈，并增强支撑力和可操作性，从而使导丝成功穿过PFO。在ICE和压力传感导管的联合引导下，成功实现了对复杂PFO的精确且安全的闭合，且未进行任何辐射暴露。我们将这种新颖的无辐射方法称为“推即通”技术，它可能为复杂长隧道型PFO的治疗提供一个有价值的选择。
