Non-intubated echocardiography-guided percutaneous closure of Patent foramen ovale in a pediatric patient via transnasal humidified rapid-insufflation ventilatory exchange (THRIVE): a case report

Background : High-flow nasal cannula oxygen therapy (HFNC) has been reported for use in digital subtraction angiography (DSA)-guided percutaneous closure of pediatric patients with congenital heart disease. Unlike conventional intubated general anesthesia, here we report a non-intubated, echocardiography-guided percutaneous closure of a patent foramen ovale (PFO) in a 13-year-old patient achieved using transnasal humidified rapid-insufflation ventilatory exchange (THRIVE), a type of HFNC. Case presentation : A 13-year-old girl was diagnosed as PFO in 2019 and underwent echocardiography-guided percutaneous closure of the PFO on July 31 ^st , 2025. Oxygen delivery was provided by THRIVE and pre-oxygenation was achieved with 30 L/min (FiO ₂ =1) for 5 minutes. Total intravenous anesthesia was used for induction and maintenance without muscle relaxants. Radial artery puncture and cannulation were performed to establish invasive blood pressure monitoring. An esophageal ultrasound probe was inserted after induction. The oxygen flow was maintained at 30 L/min (FiO ₂ =1). Spontaneous breathing was validated and qualitatively monitored by end-tidal carbon dioxide waveform. A foramen ovale occluder was placed under the guidance of echocardiography. During the closure procedure, SpO ₂ remained above 98% under with spontaneous breathing, and hemodynamics were stable. The patient was transferred to the post-anesthesia care unit (PACU) with nasal cannula oxygen (4 L/min) and awoke within 5 minutes. No sedation-related adverse events were reported during postoperative follow-up at 2 and 24 hours. Conclusion : THRIVE combined with total intravenous anesthesia (TIVA) might be an alternative anesthesia strategy for echocardiography-guided percutaneous closure of PFO in pediatric patients.