Featured Case | Successful PFO Closure Facilitated by the Astross Delivery System in Complex Anatomy

Time:

2024-10-15

Patient Information

A 45-year-old male presented with intermittent occipital headache and neck/shoulder discomfort for 2 years, unresponsive to multiple hospitalizations for suspected cervical spondylosis and lacunar cerebral infarction. Symptoms worsened significantly one month ago with frequent intolerable headaches. Cardiac ultrasound and transcranial Doppler (TCD) confirmed a patent foramen ovale (PFO).

Transesophageal Echocardiography (TEE):
A 7mm-long, 1mm-wide tunnel-like oblique defect in the mid-interatrial septum. No thrombus in left atrium/appendage.

Agitated Saline Contrast Study (Valsalva):
20-30 microbubbles/frame crossing into left atrium, confirming right-to-left shunt (RLS).

Transcranial Doppler Bubble Test:
Positive (>25 microbubbles), indicating large RLS.

Occlusion Strategy

Multidisciplinary consultation (Neurology/Cardiology) recommended PFO closure given recurrent cryptogenic lacunar infarcts.

Device Selected:D-shufo 1824-3 PFO Occluder;Delivered via 8F Astross Occluder Delivery System.

Key Advantages of Astross™ System:Puncture-sheath-like curved tip for precise septal anatomy alignment;Excellent coaxiality enabling smooth blood aspiration without pulmonary vein entry or air embolism risk;Enhanced ultrasound-guided maneuverability to simplify complex PFO anatomy access.

Intraoperative Note:The PFO opening was atypically located on the lateral wall of the septal pouch. The Astross™ system’s unique curvature successfully facilitated crossing.

Procedure Workflow

Vascular Access:
Right femoral venous access under local anesthesia (1% lidocaine); 6F sheath placement.

Septal Crossing Attempt:
Failed initial crossing attempts using standard right-heart catheter due to atypical PFO position.
→ Solution: Switched to Astross™ delivery system.

Successful Crossing:
Astross™ system guided wire across PFO into left atrium under fluoroscopic/TEE guidance.

调整输送系统角度尝试过隔

Astross输送系统辅助导丝顺利过隔

Confirmation & Deployment:

Withdrew inner core; contrast injection visualized septal pouch/PFO opening.

Deployed D-shufo 1824-3 occluder:Left atrial disc opened;Retracted to appose septum;Right atrial disc released.

TEE confirmed:Optimal device position/shape;No residual shunt;No impingement on AV valves.

Device released via counterclockwise rotation.

Conclusion:Sheath removed; hemostasis achieved.

卵圆窝处造影

封堵器成型良好

Postoperative Follow-up

Echocardiography: Stable device position, no interatrial shunt.ECG: Unchanged from preoperative baseline.

Case Summary

Complex PFO anatomy often challenges standard septal crossing, risking procedural failure or need for transseptal puncture. The Astross™ Delivery System addresses this with:

Anatomically optimized curved tip for targeted exploration/support

Enhanced crossability for atypical openings

Reduced procedural complexity under imaging guidance

Expert Profile