Successful experience of transcatheter residual right-to-left shunting closure after patent foramen ovale occlusion

Sep 30, 2026

Residual right-to-left shunting (rRLS) after patent foramen ovale (PFO) occlusion is linked to recurrent stroke, while guidance for managing such patients remains limited. This retrospective single-center study summarizes secondary interventional treatment experience. Patients with PFO occlusion lasting over one year and residual rRLS screened by contrast transthoracic echocardiography from July 2020 to January 2023 were analyzed. Secondary transcatheter closure was successful without complications, achieving complete closure in follow-up.

LanguageEnglish

CategoryHealthcare

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Pages7

Reading Time18 min

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Abstract

Background

Methods

Study participants

Echocardiography protocols and definitions

Results

Conclusion

ORIGINAL ARTICLE Cardiology Journal 2025, Vol. 32, No. 6, 562–568 DOI: 10.5603/cj.99783 Copyright © 2025 Via Medica ISSN 1897–5593 eISSN 1898–018X Successful experience of transcatheter residual right-to-left shunting closure after patent foramen ovale occlusion Lu He*, Xiaoqin Liu*, Xingye Wang, Yajuan Du, Yushun Zhang* Department of Structural Heart Disease, The First Affiliated Hospital of Xi’an Jiaotong University, China Abstract Background: Residual shunt after patent foramen ovale (PFO) occlusion is associated with recurrent stroke, and limited literature address the specific management of such cases. Herein we report our experience with secondary interventional treatment. Methods: From July 2020 to January 2023, patients who underwent PFO occlusion for more than one year with residual right-to-left shunting (rRLS) screened by contrast transthoracic echocardiography (cTTE) constituted the study population. A retrospective analysis of the basic, procedural, and follow-up data was performed. Results: A total of 35 patients with large rRLS were admitted to our center. Fourteen patients underwent transcatheter rRLS closure. Transesophageal echocardiography (TEE) clearly showed the color blood flow profile, and cTEE showed a large rRLS in 12 cases. TEE showed a small outlet near the left exit ofthe rRLS, and cTEE showed a small rRLS in two cases. Type IrRLS accounted for 71.4%, residual PFO, and residual atrial septal defect (ASD) for 14.3%, respectively. Secondary transcatheter interventions were successful in 12 patients (85.7%). No complications were observed. Six cases oftypeIrRLS were closed with ASD occluders and two with anADO-II device. Two residual PFO and two residual ASD were implanted with PFO occluders. cTTE was performed six months after the procedure, with complete closure in 12 patients. Conclusion: TEEnot only helps to improve interventional strategies to reduce residualshunt in primary occlusion but also helps in the screening of patients who are truly suitable for secondary intervention. ASD occluders can be considered as an alternative device for typeI rRLS. (CardiolJ 2025; 32, 6: 562–568) Keywords: residual shunt, right-to-left shunting, patent foramen ovale, interventional therapy Background Patent foramen ovale (PFO) occlusion is an effective means of treating PFO complicated by paradoxical embolism, which can effectively reduce the risk of PFO-associated stroke and recurrence, and alleviate migraine symptoms. Theoretically, the mechanical blocking effect of the occluder and its endothelialization will eventually completely block the anomalous passage of the atrium. However, due to the unique anatomy of PFO and the challenges in occluder selection, the incidence of residual right-to-left shunting (rRLS) after transcatheter PFO closure is much higher than that in other congenital heart diseases. Studies have reported that the complete occlusion rate one year after PFO closure is 80–90%[1–4] . The persistence of rRLS, especially large amounts of Address for correspondence: Yushun Zhang, M.D. Department of Structural Heart Disease, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 Yanta West Road, Xi’an 710068, China, tel: +86-029-85324078, e-mail: [zys2889@sina.com](zys2889@sina.com) *These three authors contributed equally to this work. Submitted: 14.03.2024 Accepted: 4.04.2025 Early publication date: 20.05.2025 This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. 562 [www.cardiologyjournal.org](www.cardiologyjournal.org) Lu He et al., Transcatheter residual right-to-left shunting closure rRLS, can lead to the occurrence or recurrence of stroke or the persistence or exa

FAQs

What clinical problem does the study address after PFO occlusion?

The study addresses residual right-to-left shunting (rRLS) after patent foramen ovale occlusion, which is associated with recurrent stroke and persistent or worsening migraine symptoms.

How were patients selected for secondary intervention?

Patients who had undergone PFO occlusion for more than one year and showed substantial rRLS at rest or after the Valsalva maneuver were screened using contrast transthoracic echocardiography between July 2020 and January 2023.

What did the results show about the effectiveness and safety of secondary transcatheter closure?

Secondary transcatheter interventions were successful in 12 patients (85.7%), and no complications were observed; complete closure was achieved in 12 patients at six-month follow-up.

Sep 30, 2026

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