Skip main navigation

Magnetic Resonance Imaging After Percutaneous Closure of a Patent Foramen Ovale

Originally published 2001;104:e117–e118

    A 51-year-old patient presented with a second episode of transient loss of vision. A persistently patent foramen ovale (PFO) was diagnosed with a transesophageal echocardiogram, and percutaneous closure with an implantable device (PfoStar, Cardia, Inc) was done. The PfoStar is a catheter implantable device consisting of 2 polyvinyl sheets spread by 2 crossed nitinol wires. The axis of the left and the right nitinol strut are shifted by 45 degrees (Figure 1). After successful implantation of a 30/3 mm device, cine MRI was performed. Quantitative flow measurements, as well as right and left ventricular voltmetry, revealed no evidence of a postprocedural shunt. The 4-chamber view (Figure 2) and a short-axis section through the atria (Figure 3) show the occluding device in situ. Only a minimal gap between the atrial septum and the device was observed. Imaging was performed on a 1.5T whole-body scanner (Intera CV, Philips Medical Systems) using single-breathhold, steady-state free precession sequences with cardiac gating. This technique allows a high spatial and temporal resolution (1.6 mm2 in-plane resolution; 23 phases per heart cycle).

    Figure 1. The implantable occluder device used for the percutaneous closure of the PFO consists of 2 polyvinyl sheets spread by 2 crossed nitinol wires.

    Figure 2. Four-chamber MRI showing the left atrial sheet of the PFO occluder (arrow).

    Figure 3. Short-axis MRI through the atrial septum perpendicular to Figure 2 shows both leaflets of the PFO occluder (arrows). LA indicates left atrium; RA, right atrium; PA, pulmonary artery; and Ao, ascending aorta.

    Percutaneous closure of a PFO has recently become an established method to reduce the risk of thrombembolic events. 1 In clinical routine, follow-up is performed by transesophageal echocardiography. MRI seems to be a useful, noninvasive, diagnostic tool to evaluate patients after interventional closure of a PFO.

    Movie versions of Figures 2 and 3 are available in an online only Data Supplement at

    The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

    Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MCI-267, Houston, TX 77030.


    Correspondence to Olaf Grebe, MD, Department of Cardiology, University of Ulm, Robert-Koch-Str 889081, Ulm, Germany. E-mail


    • 1 Windecker S, Wahl A, Chatterjee T, et al. Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of thromboembolic events. Circulation. 2000; 101: 893–898.CrossrefMedlineGoogle Scholar


    eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.

    Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.