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Detailed multidimensional assessment of patent foramen ovale (PFO) size with transesophageal echocardiography (TOE) may help to determine PFO pathogenicity in cryptogenic stroke patients and may improve the procedural outcome of percutaneous PFO closure. Purpose We explored the potential additive value of Live xPlane and three-dimensional (3D) TOE anatomical PFO sizing techniques. Methods Imaging data of 45 patients who underwent a 3D TOE-assisted PFO closure were included. The two-dimensional (2D) PFO separation distance and right to left (RL) contrast shunt magnitude were retrospectively assessed at rest and during release of a Valsalva maneuver on pre‑procedural 2D TOE recordings. Peri-procedural measurements of the triangular anatomic PFO opening (base, height and area) were performed after positioning of a stiff guidewire (SW) through the PFO, using Live xPlane imaging and 3D Zoom mode. Results The peri-procedural PFO SW base was on average five times larger than the pre-procedural 2D PFO separation (median difference +/- IQR : 13 +/- 5 mm ; p &amp;lt; 0.001), having the biggest impact on total PFO area. The width of the PFO SW base was highly variable, even for a given separation, and significantly larger in patients with a large versus a small to moderate PFO RL contrast shunt (18 versus 15 mm; p = 0.007) and in those with a spontaneous versus a provoked shunt (18 versus 14 mm; p = 0.003). Conclusion The PFO SW base, assessed by Live xPlane and 3D TOE, seems a more precise estimate of anatomical PFO size compared to the conventional 2D PFO separation distance. This new PFO dimension may be taken into account for optimization of device and patient selection strategies. Abstract P1563 Figure. 3D Zoom PFO size measurement

P1563 A new dimension in patent foramen ovale size estimation