Influencing factors of the difficulty of guidewire passing through patent foramen ovale in percutaneous closure
Objective To observe the right-to-left shunt(RLS)grade by contrast-enhanced transcranial Doppler ultrasound(c-TCD)and the patent foramen ovale(PFO)width by transesophageal echocardiography(TEE)before operation,and to investigate the influencing factors of the difficulty of guidewire passing through the foramen ovale during percutaneous closure of PFO.Methods Totally 286 PFO patients successfully underwent percutaneous closure in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2021 to December 2022.c-TCD and transthoracic echocardiography(c-TTE)were performed before operation to evaluate RLS grade,and TEE was performed to measure the width and length of PFO.Among 286 patients with PFO,the guidewire passed through the foramen ovale successfully in 260 patients(successful group),and the Swartz sheath was used to assist the guidewire to pass through in 26 patients(difficult group).The preoperative RLS by c-TCD,RLS by c-TTE,width of PFO,length of PFO,PFO classification and operation lasting time were compared between two groups.Multivariate logistic regression analysis was conducted to evaluate the influencing factors of the difficulty of the guidewire passing through the ovale foramen in percutaneous closure.Results The operation lasting time was shorter in successful group[(34.20±12.80)min]than that in difficult group[(61.07±30.33)min](t=8.597,P＜0.001),the width of PFO was greater in successful group[(1.53±0.61)mm]than that in difficult group[(1.14±0.20)mm](t=-3.047,P=0.018),the rates of RLS gradeⅣ by c-TCD and RLS grade Ⅲ by c-TTE were higher in successful group(71.92％,81.15％)than those in difficult group(11.54％,38.46％)(x2=111.374,P＜0.001;x2=24.603,P＜0.001),and there were no significant differences in the length of PFO and PFO classification between two groups(P＞0.05).RLS grade 0 by c-TCD(OR=944.684,95％CI:75.962-11 748.277,P＜0.001),RLS grade Ⅱ by c-TCD(OR=72.026,95％CI:10.102-513.544,P＜0.001),and width of PFO ≤1.14 mm(OR=0.265,95％CI:0.078-0.900,P=0.033)were the risk factors of difficulty of guidewire passing through the foramen ovale in percutaneous closure.Conclusion RLS grade ≤ Ⅱ by c-TCD and PFO width ≤1.14 mm increase the difficulty of the guidewire passing through the foramen ovale in percutaneous closure of PFO,and Swartz sheath is recommended to use.
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