Fig. 1

Procedure of a PFO closure under TEE guidance. a The closure was performed in the operating room. A 6F sheath was introduced after the vein was punctured (b, c). The distance from the right parasternal third intercostal space to the puncture site was measured and marked before the procedure for catheter insertion (d). This distance was also measured for the following insertion procedure for the super stiff guide wire and delivery sheath (f, k). e The 0.035'' super stiff guidewire. g The MP  was removed while the guidewire remained fixed in the left atrium. h The delivery system. i The occluder. j The occulder was enclosed. l The delivery sheath was inserted into the left atrium along the guide wire. m The guidewire and core had been retracted. n The device was fed along this pathway to the left atrium for PFO closure. o The puncture site