{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T16:06:31Z","timestamp":1789056391345,"version":"build-2803163510"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transcatheter closure of a patent foramen ovale (PFO) is an established strategy for secondary prevention of cryptogenic stroke in selected patients. During pregnancy, the timing and method of closure require individualized assessment of recurrent embolic risk and maternal\u2013fetal procedural risk. In selected first-trimester patients, avoiding fluoroscopy, contrast, procedural transoesophageal echocardiography (TEE), and sedation may be desirable when adequate alternative imaging is available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 34-year-old woman at 7\u2005weeks\u2019 gestation presented with acute ischaemic stroke. Work-up demonstrated a non-lacunar cortical infarct, long-tunnel PFO with a large provoked right-to-left shunt, and no alternative embolic source; the Risk of Paradoxical Embolism score was 9. After multidisciplinary discussion, early percutaneous closure was performed using a completely zero-fluoroscopy, intracardiac echocardiography (ICE)-only workflow under local anaesthesia, without procedural TEE. Key adaptations included use of a pre-shaped transseptal sheath for stable cannulation and a left atrial rail using a pre-shaped support wire. Stop-flow balloon sizing was performed and agitated saline was injected through the delivery sheath as an adjunctive visual check of left atrial position prior to device release. A 25\/18-mm Amplatzer Talisman PFO occluder was deployed successfully with no complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case demonstrated the feasibility of zero-fluoroscopy, zero-contrast PFO closure under ICE-only guidance in a carefully selected first-trimester pregnant patient. The combination of stable sheath engagement, a pre-shaped left atrial support-wire rail, stop-flow balloon sizing, and sheath-through agitated saline injection facilitated controlled device deployment without fluoroscopy or contrast. This approach depends on operator expertise and institutional familiarity with ICE-guided structural intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag635","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:17:13Z","timestamp":1788337033000},"source":"Crossref","is-referenced-by-count":0,"title":["Zero-fluoroscopy, intracardiac echocardiography\u2013only patent foramen ovale closure in early pregnancy: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2730-5491","authenticated-orcid":false,"given":"SungHo","family":"Jo","sequence":"first","affiliation":[{"name":"Department of Cardiology, Wonkwang University Hospital , 895 Muwang-ro, Iksan , Jeonbuk 54538,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4200-3456","authenticated-orcid":false,"given":"Tae-Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Hospital, Yonsei University College of Medicine , 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4526-6120","authenticated-orcid":false,"given":"Yong-Joon","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Hospital, Yonsei University College of Medicine , 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4911-8854","authenticated-orcid":false,"given":"KyeongHo","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Wonkwang University Hospital , 895 Muwang-ro, Iksan , Jeonbuk 54538,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2263-3274","authenticated-orcid":false,"given":"Jung-Sun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Hospital, Yonsei University College of Medicine , 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"2026091011113224400_ytag635-B1","article-title":"SCAI guidelines for the management of patent foramen ovale","volume":"1","author":"Kavinsky","year":"2022","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"2026091011113224400_ytag635-B2","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"Kleindorfer","year":"2021","journal-title":"Stroke"},{"key":"2026091011113224400_ytag635-B3","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/j.jcin.2018.06.056","article-title":"Intracardiac echocardiography in structural heart disease interventions","volume":"11","author":"Alkhouli","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"2026091011113224400_ytag635-B4","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1177\/1747493017743801","article-title":"Canadian stroke best practice consensus statement: secondary stroke prevention during pregnancy","volume":"13","author":"Swartz","year":"2018","journal-title":"Int J Stroke"},{"key":"2026091011113224400_ytag635-B5","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/j.1540-8183.2001.tb00733.x","article-title":"Echocardiographically guided closure of a patent foramen ovale during pregnancy after recurrent strokes","volume":"14","author":"Daehnert","year":"2001","journal-title":"J Interv Cardiol"},{"key":"2026091011113224400_ytag635-B6","first-page":"579","article-title":"Percutaneous device closure of the patent foramen ovale during pregnancy","volume":"69","author":"Schrale","year":"2007","journal-title":"Catheter Cardiovasc Interv"},{"key":"2026091011113224400_ytag635-B7","doi-asserted-by":"crossref","first-page":"e210","DOI":"10.1097\/AOG.0000000000002355","article-title":"Committee Opinion No. 723: guidelines for diagnostic imaging during pregnancy and lactation","volume":"130","author":"American College of Obstetricians and Gynecologists","year":"2017","journal-title":"Obstet Gynecol"}],"container-title":["European Heart Journal - 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