Background Patent foramen ovale (PFO) closure is traditionally guided by transoesophageal echocardiography (TEE) under general anaesthesia, which prolongs procedure duration and increases costs and risks. A transnasal echocardiography with a microTEE-probe (microTNE) is tolerated under conscious sedation and offers an effective alternative to TEE. The aim of this study was to compare the feasibility, safety and time expenditure of PFO closure using conventional TEE versus microTNE guidance. Methods Consecutive patients assigned for PFO losure in Helsinki University Hospital from 2003 to 2021 were included in the study (n=336). TEE with general anaesthesia was used until November 2018 (n=167) while microTNE-guided PFO closure (n=169) under conscious sedation was the principal method thereafter. Patients were followed for 3 months after PFO closure. Results The microTNE-route success rate was 97.2% vs TEE 100% (p=0.06) and procedure success rate was 97.7% with microTNE and 96.0% with TEE-guidance (p=0.54). The procedure time was significantly shorter with microTNE 21±7 min than with TEE 30±13 min (p<0.001). At the beginning of microTNE era, nasal bleeding complication was quite frequent; however, overall complication rates were equal between the groups. However, C reactive protein (CRP) increase was significantly milder with microTNE than TEE 1.0±2.9 vs 3.0±4.0 mg/L (p<0.001). An increase in CRP was independently associated with procedure type (p=0.004) and time (p=0.003). Conclusions MicroTNE is a feasible and safe alternative for PFO closure guidance. MicroTNE under conscious sedation shortens procedure duration and induces a milder inflammatory reaction than conventional TEE under general anaesthesia. Data are available on reasonable request.

中文翻译：

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微探针与传统经食管超声心动图指导 PFO 封堵的比较评估

背景 卵圆孔未​​闭（PFO）封堵传统上是在全身麻醉下通过经食管超声心动图（TEE）引导，这会延长手术时间并增加成本和风险。使用 microTEE 探头 (microTNE) 进行的经鼻超声心动图在清醒镇静下可以耐受，并且提供了 TEE 的有效替代方案。本研究的目的是比较使用传统 TEE 与 microTNE 引导进行 PFO 封堵的可行性、安全性和时间消耗。方法 2003 年至 2021 年在赫尔辛基大学医院连续分配的 PFO 丢失患者纳入研究 (n=336)。全身麻醉下的 TEE 一直使用到 2018 年 11 月（n = 167），而意识镇静下的 microTNE 引导 PFO 封堵术（n = 169）是此后的主要方法。PFO 闭合后对患者进行了 3 个月的随访。结果 microTNE 途径的成功率为 97.2%，而 TEE 为 100% (p=0.06)，microTNE 的手术成功率为 97.7%，TEE 引导的手术成功率为 96.0% (p=0.54)。microTNE 的手术时间为 21±7 分钟，比 TEE 的 30±13 分钟显着缩短 (p<0.001)。microTNE时代初期，鼻出血并发症相当频繁；然而，各组之间的总体并发症发生率相同。然而，microTNE 组的 C 反应蛋白 (CRP) 升高程度明显低于 TEE 组 (1.0±2.9 vs 3.0±4.0 mg/L) (p<0.001)。CRP 的升高与手术类型 (p=0.004) 和时间 (p=0.003) 独立相关。结论 MicroTNE 是 PFO 封堵指导的可行且安全的替代方案。与全身麻醉下的传统 TEE 相比，清醒镇静下的 MicroTNE 缩短了手术时间并引起更轻微的炎症反应。可根据合理要求提供数据。