How i do it: ICE-guided technique for percutaneous pfo closure

Closing a patent foramen ovale (PFO) under guidance with intracardiac echocardiography (ICE) affords multiple advantages compared to guidance with transesophageal echocardiography. These include patient comfort with same-day discharge and avoidance of general anesthesia or deep sedation. A good understanding of the anatomy and troubleshooting techniques is important to avoid causing injury or performing inadequate device closure due to limited visualization or unusual septal configurations. This chapter presents an overview of ICE imaging and the relevant PFO anatomy, as well as catheter manipulation techniques used for the percutaneous closure procedure. In addition, this chapter will present several cases to showcase different methods that can be used to manage a challenging anatomy.