Targeted neonatal echocardiography(TNE)refers to the purposeful use of echocardiography to assess neonatal cardiovascular physiology and hemodynamics,with the aim of improving diagnosis and treatment in the neonatal intensive care unit.Neonatal cardiac point-of-care ultrasound(cPOCUS)is a limited cardiovascular evaluation focused on catheter tip position assessment,identification of pericardial effusion,and differentiation between hypovolemia and severe reduction in myocardial contractility in hemodynamically unstable neonates.The guideline"Guidelines and recommendations for targeted neonatal echocardiography and cardiac point-of-care ultrasound in the neonatal intensive care unit:an update from the American Society of Echocardiography"covers five main areas:(1)purpose and basic principles of TNE and cPOCUS;(2)an overview of the components of a standard TNE and cPOCUS evaluation;(3)disease-and/or clinical scenario-based indications for TNE;(4)training and competency-based assessment requirements for TNE and cPOCUS;and(5)components of quality assurance.This article selectively interprets the first two areas of the guideline.

BackgroundDiffuse pulmonary arteriovenous malformations (PAVMs) are a rare but serious complication after the Glenn procedure. Clinically, they typically present with progressive hypoxemia, which can lead to worsening cyanosis, reduced exercise tolerance, and may even progress to heart failure.Case summaryWe report an 8-year-old boy with complex congenital heart disease, including double outlet right ventricle, ventricular septal defect, atrial septal defect, and pulmonary stenosis. He underwent a bidirectional Glenn procedure at 6 months of age and subsequently developed progressive cyanosis. At 5 years old, he presented to our center, where comprehensive evaluation confirmed extensive PAVMs. Consequently, an extracardiac total cavopulmonary connection (TCPC) was performed. During the 3-year postoperative follow-up, the PAVMs completely resolved, oxygen saturation normalized, and clinical symptoms improved markedly.ConclusionIn patients with a history of Glenn procedure who present with unexplained hypoxemia, the possibility of postoperative PAVMs should be carefully considered. Early diagnosis and timely intervention can significantly improve outcomes. This case highlights the therapeutic value of TCPC in managing this complication.

Currently, no unified standardized protocols exist for myocardial longitudinal strain measurement in functional single ventricle (FSV) patients, causing inconsistent methodologies in clinical practice and related studies. Some studies use only the apical four-chamber view, while others employ three apical views. This study aimed to determine whether longitudinal strain (LS-4CH) measured from the apical four-chamber view can serve as an effective substitute for the average global longitudinal strain (GLS-AV) derived from multiple apical views in different subtypes of FSV patients. This retrospective study enrolled 34 FSV patients. The consistency between LS-4CH and GLS-AV was assessed via Bland-Altman analysis, intraclass correlation coefficient (ICC), Lin’s concordance correlation coefficient (CCC), and Passing-Bablok regression, with Two One-Sided Tests (TOST) for formal equivalence verification. Intra- and inter-observer ICC were used to evaluate the repeatability of the two methods. Spearman’s correlation analyzed the associations of LS-4CH and GLS-AV with cardiac magnetic resonance-derived ejection fraction (CMR-EF). Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of each index for predicting CMR-EF < 50

Although cardiac tumor in children are clinically rare, they present significant diagnostic challenges. This study aims to characterize the echocardiographic features of pediatric cardiac tumor and to correlate these findings with surgical and pathological results, thereby improving diagnostic accuracy. A further objective is to conduct long-term follow-up of surgical patients to provide insights into the prognosis and management of primary cardiac tumors in this population. A retrospective analysis was conducted on pediatric patients under 18 years of age with cardiac tumor confirmed by both echocardiography and surgical pathology at our institution from January 2004 to January 2025. The inclusion criterion was confirmation of the lesion by both preoperative echocardiography and postoperative pathological analysis following surgical resection. Demographic and clinical data, including gender, age, clinical manifestations, and arrhythmias, were qualitatively summarized. Echocardiographic, surgical, and pathological findings were statistically analyzed. Long-term follow-up was performed to assess tumor recurrence, postoperative complications, and overall prognosis. Of the 18 pediatric patients included, 11 (61.1

PRKAG2 syndrome is a rare glycogen-storage cardiomyopathy that can mimic sarcomeric hypertrophic cardiomyopathy (HCM). The diagnostic clue is not left ventricular hypertrophy alone, but the combination of hypertrophy with ventricular pre-excitation and conduction-system abnormalities. This pattern is clinically important because PRKAG2 syndrome differs from sarcomeric HCM in disease progression, arrhythmic risk, and long-term management. A 12-year-old boy presented with recurrent exertional chest tightness. Twelve-lead electrocardiography showed ventricular pre-excitation, and echocardiography demonstrated asymmetric non-obstructive left ventricular hypertrophy. An external Holter report recorded sinus bradycardia and nocturnal pauses. Genetic testing identified a heterozygous PRKAG2 variant, NM_016203:c.1423A>G (p.Lys475Glu), classified as likely pathogenic. The available report from a clinically indicated invasive electrophysiological procedure documented persistent pre-excitation and localized the earliest antegrade ventricular activation to the right midseptal para-Hisian region. Catheter ablation was deferred because no tachyarrhythmia had been documented and ablation near the His bundle carried a substantial risk of atrioventricular block. During approximately 2 years of follow-up, the patient remained clinically stable, with persistent hypertrophy and no major arrhythmic or conduction events. In adolescents with otherwise unexplained ventricular hypertrophy, ventricular pre-excitation should prompt consideration of PRKAG2 syndrome and other HCM phenocopies, even without a positive family history. Recognition of this combined structural and electrical phenotype may facilitate earlier genetic diagnosis and guide long-term rhythm surveillance. The mechanism of pre-excitation should be described only to the extent supported by the available electrocardiographic and procedural documentation.

BackgroundHolt-Oram syndrome, also known as atrio-digital syndrome, is a rare autosomal dominant genetic disorder primarily characterized by upper limb malformations and congenital heart defects, associated with mutations in the TBX5 gene. Diagnosis is typically based on clinical presentation, and the prognosis for affected individuals is closely related to the severity of cardiac involvement. Our study aims to highlight some key features of Holt-Oram syndrome to improve the level of clinical diagnosis.MethodsWe collected 11 patients with clinical features strongly suggestive of Holt-Oram Syndrome at the First Affiliated Hospital of Tsinghua University from January 2010 to January 2025. These patients exhibited both limb malformations and cardiac abnormalities. We then analyzed the characteristics of their diseases.ResultsThe skeletal abnormalities and cardiac defects presented in diverse forms among the 11 patients. Among the congenital heart diseases, atrial septal defect (ASD) was the most common, accounting for 80% of cases. However, some patients presented with severe conditions such as tetralogy of Fallot or Ebstein's anomaly. Regarding upper limb malformations, the most frequent finding was triphalangeal thumb (8/10 patients), but thumb hypoplasia or aplasia and radial bone abnormalities were also observed.ConclusionThe predominant cardiac structural abnormality in this group of patients was atrial septal defect. Upper limb malformations were predominantly characterized by polydactyly or syndactyly. However, arrhythmias appeared to be mainly supraventricular tachycardia, and upper limb involvement did not seem to show a clear left-sided predominance. The prognosis following cardiac corrective surgery was favorable. Nevertheless, for this condition, emphasis should be placed on prevention.

Background: PRKAG2 syndrome is a rare autosomal dominant glycogen storage cardiomyopathy caused by pathogenic variants in the PRKAG2 gene. It typically presents with left ventricular hypertrophy, ventricular pre-excitation, and conduction system disease, which can closely mimic sarcomeric hypertrophic cardiomyopathy (HCM) on routine imaging. Early recognition is crucial because its natural history, arrhythmic risk, and management differ substantially from those of classic hypertrophic cardiomyopathy. Case presentation: A 12-year-old boy presented with exertional chest tightness. Physical examination revealed a grade 2/6 systolic murmur at the left sternal border, while serial electrocardiograms demonstrated intermittent ventricular pre-excitation. Twenty-four-hour Holter monitoring recorded sinus bradycardia with intermittent pre-excitation, rare supraventricular ectopy, and multiple sinus pauses longer than 2 seconds (maximum RR interval of 2.28 seconds), occurring predominantly during sleep. Transthoracic echocardiography revealed asymmetric left ventricular hypertrophy with preserved systolic function and no evidence of left ventricular outflow tract obstruction. He was initially diagnosed with non-obstructive hypertrophic cardiomyopathy, intermittent ventricular pre-excitation, sick sinus syndrome, sinus bradycardia, and sinus arrest. However, the coexistence of myocardial hypertrophy, ventricular pre-excitation, and conduction abnormalities raised strong clinical suspicion for PRKAG2 syndrome. Subsequent genetic testing identified a heterozygous pathogenic missense variant in PRKAG2 , confirming the diagnosis. An electrophysiological study localized a fasciculoventricular pathway adjacent to the His bundle. Radiofrequency catheter ablation was deferred due to the high risk of complete atrioventricular block and the absence of documented tachyarrhythmia. During 1 year of follow-up, the patient remained clinically stable without high-risk arrhythmic events. Conclusions: This case highlights the importance of considering PRKAG2 syndrome in young patients presenting with left ventricular hypertrophy accompanied by ventricular pre-excitation and conduction abnormalities. Genetic testing is essential for distinguishing PRKAG2 syndrome from sarcomeric hypertrophic cardiomyopathy and for guiding accurate risk stratification and individualized management.

Background:As survival among patients with congenital heart disease (CHD) has improved, scoliosis after cardiac surgery has increasingly been recognized. However, the clinical characteristics and risk factors associated with scoliosis severity remain incompletely understood. Methods:We retrospectively reviewed patients who underwent cardiac surgery for CHD at our center between 2000 and 2022 and conducted long-term follow-up. Patients who developed scoliosis were matched with controls without scoliosis using propensity score matching (PSM). Clinical and radiographic data were analyzed. Logistic regression was used to identify independent risk factors for greater scoliosis severity, and Kaplan-Meier analysis to evaluate cumulative incidence. Associations between cardiac morphology and scoliosis severity were also assessed. Results:A total of 39 patients who developed scoliosis after CHD surgery and 39 matched patients without scoliosis were included. The median follow-up duration for the overall cohort was 12.75 (10.55-18.15) years. Compared with the non-scoliosis group, patients with scoliosis had a significantly higher cardiothoracic ratio (CTR) [55.48 [51.68-58.81] vs. 52.04 [46.62-55.56], P = 0.004]. Among patients with scoliosis, females accounted for 58.97%, and the median age at scoliosis diagnosis was 10.56 (8.54-13.16) years. Single thoracic curves predominated, with the apical vertebra most commonly located at the T8-T9 level. Cardiac surgery before 1 year of age was more common among patients with higher Cobb angles and was associated with earlier scoliosis onset. Patients with higher Cobb angles had a higher CTR than those with lower Cobb angles [58.48 [55.39-61.68] vs. 52.85 [49.25-55.88], P = 0.003], and CTR was positively correlated with Cobb angle (r = 0.494, P = 0.001). Multivariate logistic regression showed that a higher CTR was independently associated with greater scoliosis severity (OR 4.79, 95% CI 1.01-22.68, P = 0.048). Relative leftward extension of the cardiac silhouette was positively correlated with Cobb angle (r = 0.470, P = 0.003). Conclusions:Scoliosis after cardiac surgery for CHD most commonly presented as a right-convex single thoracic curve. A higher CTR was associated with both the presence of scoliosis and greater scoliosis severity. Long-term spinal surveillance should be considered, particularly in high-risk children.

Background:Heterotaxy syndrome (HS) is a rare and complex congenital disorder characterized by abnormal development of the left-right axis and heterogeneous cardiovascular malformations. HS is associated with substantial morbidity and mortality, posing significant clinical challenges. Despite surgical advances, global research trends in HS remain poorly characterized. This study aimed to systematically analyze the global research landscape of HS from 2006 to 2025 using bibliometric methods, identify emerging themes, and highlight areas of clinical relevance. Methods:Publications on HS published from 2006 to 2025 were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric analyses were performed using CiteSpace and VOSviewer to assess publication trends, collaboration networks, journal distributions, and research hotspots. Results:A total of 493 publications involving 2,548 authors from 184 journals were included. Overall, publication output increased over time, peaking in 2022. The United States was the leading contributor to research productivity. Harvard Medical School and Boston Children's Hospital were the leading institutions. Anderson RH was identified as the most prolific author, whereas Cardiology in the Young was the most productive journal in this field. Keyword and co-citation analyses revealed a transition from anatomical classification and staged surgical palliation toward genetic mechanisms, prognostic assessment, and long-term outcome evaluation. Conclusions:HS research remains in an evolving stage of development. This study outlines emerging research directions and thematic trends as the first bibliometric analysis in this field. These findings provide clinicians and researchers with a clearer understanding of the current research landscape and may serve as a reference for future investigations aimed at improving the management and outcomes of patients with HS.

Coxiella burnetii is an important cause of blood culture-negative infective endocarditis (IE). Pediatric C. burnetii endocarditis is rare, particularly in patients with prosthetic cardiovascular materials. A 13-year-old boy with pulmonary atresia who had undergone Rastelli repair followed by replacement with a valved right ventricle-to-pulmonary artery (RV-PA) conduit presented with recurrent fever and a mobile intraconduit mass. Transthoracic echocardiography (TTE) showed a vegetation in the pulmonary valve/conduit region, and cardiac computed tomography (CT) confirmed a corresponding filling defect without periconduit abscess or pseudoaneurysm. Blood metagenomic next-generation sequencing (mNGS) detected C. burnetii, while indirect immunofluorescence assay (IFA) showed positive phase I and phase II IgG antibodies. The conduit vegetation and blood detection of C. burnetii fulfilled major imaging and microbiological criteria, respectively, under the 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria. An individualized regimen of doxycycline, trimethoprim-sulfamethoxazole (TMP-SMX), and hydroxychloroquine was followed by clinical improvement and reduction in lesion size during hospitalization. C. burnetii should be considered in children with prosthetic cardiovascular materials who present with persistent fever and negative conventional blood cultures. Molecular testing, serology, and multimodality cardiac imaging can support diagnosis and early follow-up.

While this syndrome is associated with bicuspid aortic valve, here we report a case presenting with Shone's syndrome complicated by unicuspid aortic valve.

Aim: Congenital heart defects (CHDs) are a major component of heterotaxy syndrome (HS), contributing significantly to high morbidity and mortality. The anatomical variability, surgical complexity, and poor prognosis of HS-associated CHDs present major clinical challenges. Material and Methods: We retrospectively reviewed 292 patients diagnosed with HS and CHDs at The First Hospital of Tsinghua University between January 2014 and December 2023. Demographic information and cardiac imaging data were collected to analyze the spectrum of cardiac malformations, spleen anatomy, sex distribution, and the frequency and distribution of major structural abnormalities. Results: The cohort included 292 patients (mean age 6.8±8.7 years), with females accounting for 40.8%. Dextrocardia was present in 50%. The asplenia type was most common (42.8%), followed by unisplenia (41.8%) and polysplenia (15.4%). The most frequent cardiac malformations were single ventricle (61.9%), conotruncal anomalies (54.5%), and pulmonary stenosis (42.8%). The overall incidence of anomalous pulmonary venous connection was 7.8%, with total anomalous pulmonary venous connection (TAPVC) accounting for 6.8%. Gender analysis revealed a significantly higher proportion of males in the asplenia group (66.4% vs. 33.6%, P<0.05) and in the unisplenia group (59.0% vs. 41.0%, P<0.05). Although females were more frequent in the polysplenia group (57.8% vs. 42.2%), the difference was not statistically significant (P>0.05). Conclusion: HS with CHDs presents with complex and diverse anatomical abnormalities and is associated with challenging management and poor prognosis. This ten-year single-center study provides a comprehensive overview of the clinical spectrum of HS-associated CHDs and reveals significant sex differences among patients with asplenia, unisplenia, and polysplenia. These findings may contribute to clinical classification, preoperative assessment, and individualized management strategies.

Functional single ventricle represents a complex congenital cardiac malformation where ventricular function directly impacts patients’ quality of life and prognosis. Accurate assessment of ventricular function in FSV patients is crucial for treatment planning, surgical intervention, and monitoring therapeutic efficacy. Echocardiography, as a non-invasive, readily available, and real-time cardiac imaging modality, has emerged as the preferred method for evaluating functional single ventricle ventricular function. With continuous advancement and innovation in echocardiographic technology, methods for evaluating functional single ventricle ventricular function have become increasingly diverse and refined. This review synthesizes recent research developments in echocardiographic assessment of functional single ventricle ventricular function and analyzes the advantages, limitations, and future applications of various techniques. Strain and strain rate derived from two-dimensional speckle tracking imaging have progressively entered clinical application, demonstrating substantial potential as crucial parameters for evaluating single ventricular function. Emerging technologies, including three-dimensional speckle tracking imaging and non-invasive pressure-strain loops, show promise for contributing to multi-dimensional, integrated assessment as research continues to advance.

BACKGROUND: The discovery of anomalous hepatic vein drainage into the atrium following extracardiac total cavopulmonary connection in patients with single ventricle is extremely rare. This study aims to enhance our understanding of this phenomenon. CASE PRESENTATION: We report a case of a congenital heart disease patient who underwent extracardiac total cavopulmonary connection. Postoperatively, the patient experienced progressive low oxygen saturation and cyanosis. Cardiac catheterization and contrast CT revealed hepatic vein drainage into the atrium. Surgical ligation of the hepatic vein was performed, resulting in normalization of oxygen saturation and significant improvement of cyanosis. The patient has been in good condition during follow-up. CONCLUSION: For patients experiencing progressive cyanosis and hypoxemia after extracardiac total cavopulmonary connection, the possibility of anomalous hepatic vein drainage should be considered, although rare. This can be confirmed through cardiac catheterization or contrast enhanced CT. Ligation of the anomalous hepatic vein can significantly improve the condition.

BACKGROUND: In biventricular circulation, myocardial work indices derived from pressure-strain loops (PSL) show potential for effectively evaluating ventricular function in both left and right ventricles. However, these novel myocardial work parameters have not been extensively investigated in patients with functional single ventricle (FSV). OBJECTIVES: To assess the relationship between myocardial work indices and parameters from cardiac catheterization in FSV patients, and to compare differences between functional single ventricle subtypes. METHODS: This retrospective study analyzed 38 FSV patients, including 17 with single left ventricle (SLV) patients and 21 with single right ventricle (SRV) patients. All patients underwent echocardiography and cardiac catheterization on the same day. To analyze correlations, Spearman’s rank correlation coefficient was applied, while receiver operating characteristic (ROC) curves were developed to evaluate predictive accuracy. RESULTS: Compared to SLV patients, SRV patients exhibited significantly higher global wasted work (GWW) (194.0 [132.5, 309.5] vs. 101.0 [66.5, 143.5] mmHg%, p = 0.012) accompanied by significantly reduced global work efficiency (GWE) (86.0% [81.5, 90.0] vs. 93.0% [89.5, 95.0], p = 0.004). In all FSV patients, global work index (GWI) (r=-0.540, p < 0.01), global constructive work (GCW) (r=-0.436, p < 0.01), and GWE (r=-0.831, p < 0.001) showed significant negative correlations with ventricular end-diastolic pressure (VEDP), while GWW demonstrated a significant positive correlation with VEDP (r = 0.738, p < 0.001). PSL parameters exhibited good intra- and inter-observer reproducibility and high predictive value for VEDP > 10 mmHg. CONCLUSIONS: Pressure-strain loop indices can effectively evaluate cardiac function in FSV patients and reveal functional differences between subtypes. Larger studies are needed to validate the value of these emerging indicators.

BACKGROUND Antiphospholipid syndrome (APS) is a chronic autoimmune disease characterized by venous or arterial thrombosis, pregnancy morbidity and a variety of other autoimmune and inflammatory complications. Here, we report a case of APS associated with multiple coronary thromboses. CASE SUMMARY The patient, a 28-year-old male, suffered from recurrent coronary thromboses over a period of 31 months. Despite undergoing interventional coronary procedures, thrombolytic therapy, and anticoagulation treatment, the condition persisted intermittently. An extensive search for underlying thrombogenic factors revealed a diagnosis of APS. Accurate adjustment of the medication regimen led to the absence of further acute coronary syndrome (ACS) episodes during the subsequent 20-month follow-up. Although the patient occasionally experiences chest tightness, no further symptoms of distress have been reported. CONCLUSION APS can manifest as ACS. Screening for rheumatologic and immunological conditions is essential when encountering patients with multiple coronary thromboses. Treatment strategy should include symptomatic relief and a targeted and aggressive approach to address the underlying pathophysiology.

BACKGROUND:Ebstein's anomaly (EA) is a rare and complex congenital heart anomaly, and the effect of surgical treatment is not ideal. This study aims to introduce our experience in management strategies, surgical techniques, and operative indications for patients with Ebstein's anomaly.METHODS:A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020. 32 patients had previously received cardiac surgery in other hospitals. The clinical data including diagnosis, operative indications, techniques, pathological changes, and survival rates were collected and analyzed.RESULTS:Anatomical correction was performed in 203 (78.7%) operations, 1½ ventricle repair in 38 (14.7%) operations, tricuspid valve repair only in four operations (1.6%), tricuspid valve replacement in ten (3.9%), total cavopulmonary connection (TCPC) in two (0.8%), and Glenn operation in one operation (0.4%). Reoperation was performed in five patients (2.0%) during hospitalization. Among them, tricuspid valve replacement was performed in one patient, 1½ ventricle repair in two patients, and tricuspid valve annulus reinforcement in two patients. Five patients died with an early mortality rate of 2.0%. Complete atrioventricular conduction block was complicated in one patient (0.4%). A total of 244 patients was followed up (four in the 253 patients lost) with a duration of 3.0-168.0 (87.6 ± 38.4) months. Cardiac function of 244 patients improved significantly with mean New York Heart Association (NYHA) functional class recovery from 3.5 to 1.1. The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5. Three late deaths (1.2%) occurred. The survival rates at five and ten years after surgery were 98.6% and 98.2%, respectively. Reoperation was performed in five patients (2.0%) during the follow-up period.CONCLUSION:Based on our management strategies and operative principles and techniques, anatomical correction of EA is capable of achieving excellent long-term results, and low rates of TCPC, 1½ ventricle repair and valvular replacement.

Juxtaposition of the atrial appendages is an extremely rare congenital cardiac malformation. It is usually discovered incidentally during autopsy or surgery. This report aims to increase awareness of right juxtaposition of the left atrial appendage. We report a Chinese Han female aged 2 years and 10 months with recurrent lung infections after birth, who was diagnosed with congenital heart disease, corrected transposition of the great arteries, ventricular septal defect, and arterial ductus arteriosus at the local hospital and improved after the pulmonary artery banding procedure. The patient presented to our hospital with intermittent cough. During preoperative evaluation, a review of imaging data revealed a right juxtaposition of the left atrial appendage on enhanced computed tomography. Right juxtaposition of the left atrial appendage is a rare congenital heart anomaly that often occurs in conjunction with complex cardiac malformations. Diagnosis requires a combination of imaging modalities to improve detection rates. Careful identification of cardiac structures during surgery is crucial, as alterations in cardiac anatomy may increase surgical risks. For instance, the opening of juxtaposed atrial appendages could be mistaken for an atrial septal defect.

Objectives To investigate the clinical values of right heart contrast transthoracic echocardiography (cTTE) combined with migraine rating scale in evaluating the efficacy of patent foramen ovale (PFO) closure. Methods From January 2018 to December 2021, a total of 68 hospitalized patients, 21 males and 47 females, who were treated with transcatheter closure of PFO-induced migraine in the Heart Center of the First Affiliated Hospital of Tsinghua University were selected, with the age of 38.4 ± 11.9 years old. The changes of right heart contrast transthoracic echocardiography (cTTE), visual analogue pain score(VAS), headache impact test-6(HIT-6) and migraine disability assessment questionnaire(MIDAS) before and 6 months after PFO occlusion were compared. Results Pre-operative cTTE data show that 36 patients (52.9%) had moderate right-to-left shunt (RLS), and 32 patients (47.1%) had massive RLS. cTTE was reexamined 6 months after operation and 1 case in the moderate RLS group had minimal RLS, 2 cases in the large RLS group had minimal RLS, and no shunts were seen for the rest. The VAS, HIT-6 and MIDAS scores before and 6 months after the operation were 7.65 ± 1.39 vs. 1.28 ± 1.53, 70.78 ± 6.82 vs. 41.53 ± 6.07, and 30.60 ± 13.24 vs. 1.93 ± 3.87, respectively. All the indexes 6 months after the operation significantly improved compared with the preoperative baseline ( P < 0.05). Conclusions cTTE combined with migraine evaluation scale could be used as an objective index to evaluate the clinical effect of PFO occlusion.