To the Editor: Dr Wahl and colleagues studied the short- and long-term safety and efficacy of percutaneous closure of patent foramen ovale (PFO) for prevention of paradoxical embolisation using fluoroscopic guidance only.1 While we command their technical skills, we disagree that using fluoroscopy only is the safest and most efficient approach to percutaneous PFO closure. The authors correctly note that to date there are no randomised controlled trials that have shown improvement in hard clinical end points with PFO …