Patent foramen ovale – pivotal role of transesophageal echocardiography in the indications for closure, assessment of varying anatomies and post-procedure follow-up

Patent foramen ovale (PFO) is present in 15–30% of the general population and has been associated with various pathological states, including cryptogenic stroke, platypnea-orthodeoxia, decompression sickness, and migraine with auras. Transesophageal echocardiography (TEE) has a major role in the diagnostic evaluation of PFO as well as in the post-procedural assessment after transcatheter closure. The purpose of the present paper was to synthesize the echocardiographic transesophageal techniques required for accurate PFO diagnosis and careful anatomic assessment of its anatomic variants, to focus TEE indications for device closure as complementary to clinical indications and to assess the role of TEE in the post-procedure follow-up.