Introduction: Patent foramen ovale (PFO) is found in 25% of population. Percutaneous closure of PFO has specific indications (paradoxical embolism, decompression sickness, migraine) and is recommended to be performed under echocardiographic guidance. This guidance can be done either by transesophageal echocardiography (TEE) or intracardiac ecography (ICE). The study compares the results obtained by using TEE or by using ICE. Methods: Between March, 2009 and May, 2014, 772 PFO closure procedures took place at the Policlinico San Donato, Milan. Two comparative groups were formed and analyzed retrospectively: group A – 55 cases of percutaneous closure technique using ICE, group B – 55 cases, similarly constituted group A, using TEE. Results: Th e success rate in closing PFO was 100% in both groups, by using multiple types of devices (Amplatzer PFO Occluder, Amplatzer Cribriform Occluder, Septal Occluder Gore, Cardia Atriasept, Premere PFO). Significant differences between groups were found on fl uoroscopy time (group A 7.2 ± 4.2 min. vs group B 3.2 ± 1.4 min., p = 0.07). Th ere were no signifi cant diff erences between groups regarding the duration of the procedure (group A 30.0 ± 7.4 min. vs group B 23.7 ± 5.9 min., p = NS) or complications. Conclusions: ICE can be considered an optional imaging method in patients requiring closure of the PFO, especially considered when there are contraindications to TEE. ICE can replace TEE with a higher cost price and radiation exposure.