Objective To analyze the efficacy and safety of closure of patent foramen ovale (PFO) guided by transesophageal echocardiography (TEE), and summarize the experience of some difficult cases. MethodsThe patients who underwent the percutaneous PFO occlusion in our hospital from January 2020 to May 2023 were retrospectively enrolled. Dynamic monitoring data of TEE before, during, and after the operation were recorded. Results A total of 68 patients including 30 males and 38 females at an average age of 45.6±16.3 years were included. There were 7 patients with complex PFO. Under TEE guidance, 65 patients successfully completed the occlusion treatment, and 3 patients failed to close. During the operation, the two-dimensional TEE images of the patients were clear, which fully and clearly showed the process of the sheath canal passing through the ovale foramen and the continuous observation of the occlusive umbrella after releasing the occlusive umbrella. The position of the umbrella was secure and the shape of the umbrella was satisfactory. No blood shunt or pericardial effusion was found at 6-month and 1-year follow-up. The heart structure and heart rhythm were improved, the atrioventricular valve function was normal, the blocking umbrella was firm and stable, and there was no shedding or displacement. ConclusionThe percutaneous PFO occlusion guided by TEE is safe and effective, and has fewer side effects on patients compared with traditional interventional methods, but the complex PFO occlusion surgery is still challenging.