Objective To explore the application value of contrast transthoracic echocardiography (cTTE) in interventional closure surgery for elderly patients with patent foramen ovale (PFO). Methods Data were collected from 103 highly suspected elderly patients with PFO admitted to Xuchang Central Hospital from July 2022 to December 2023. All patients underwent cTTE examination, and those who were clinically diagnosed and met the surgical indications received interventional closure treatment. After surgery, the surgical effect was rechecked by cTTE. Record the surgical results, as well as the cTTE diagnosis results, and compare the preoperative and postoperative right to left shunt (RLS) grading results. Results Of the 103 patients suspected of having a PFO, 62 cases were confirmed as PFO, while the remaining 41 were non-PFO. The accuracy of cTTE in diagnosing PFO was 87.38% (90/103), sensitivity was 90.32% (56/62), specificity was 82.93% (34/41), positive predictive value (PPV) was 88.89% (56/63), negative predictive value (NPV) was 85.00% (34/40), and the consistency κ value with surgical results was 0.736 (P＜0.05). Among the 62 patients, 51 ultimately underwent interventional closure surgery, with a success rate of 100%. After 6 months of follow-up, the right to left shunt grading of 51 patients treated with interventional closure surgery decreased compared to preoperative levels (P＜0.05). Conclusion cTTE examination serves as an effective preoperative diagnostic tool for detecting PFO, guiding the implementation of interventional closure procedures, and demonstrating significant clinical value in improving RLS grading outcomes in patients.