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 Incidental Finding of Patent Foramen Ovale during Cardiac Surgery: Should it Always be Repaired?
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Anesth Analg 2007;105:602-610
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000278735.06194.0c

CARDIOVASCULAR ANESTHESIA

The Incidental Finding of a Patent Foramen Ovale During Cardiac Surgery: Should It Always Be Repaired? A Core Review

Mikhail R. Sukernik, MD, PhD*, and Elliott Bennett-Guerrero, MD{dagger}

From the *Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; and {dagger}Duke Clinical Research Institute, Durham, North Carolina.

Address correspondence and reprint requests to Mikhail R. Sukernik, MD, PhD, Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, P.O. Box 850, H-187, Hershey, PA 17033. Address e-mail to mrs21{at}columbia.edu.

With the increased use of intraoperative transesophageal echocardiography, patent foramen ovale (PFO) has become a common finding during heart surgery. This finding presents a difficult dilemma for cardiac surgeons, since the impact of intraoperatively diagnosed PFOs on postoperative outcome is unknown. Changes in the surgical plan required for closure of a PFO subject the patient to the possibility of additional risk. On the other hand, a decision to not close a PFO exposes the patient to unclear immediate and long-term consequences. Deciding whether or not to close a PFO currently depends on the clinicians’ personal preferences, the probability of intraoperative and postoperative hypoxemia, and any anticipated deviation from the initial surgical plan. Most clinicians agree that an intraoperatively diagnosed PFO must be closed when surgery leads to a high risk of hypoxemia (e.g., left ventricular assist devices placement, heart transplantation); should be closed in most cases when minimal deviation from the initial surgical plan is needed for PFO closure (e.g., mitral valve or tricuspid valve surgeries); and probably, should be closed during heart surgeries performed without atriotomy and bicaval cannulation when the risk of perioperative or remote PFO-related complications is increased. The recent development of percutaneous methods of PFO closure provides a valuable backup for those cases when PFO is not closed and postoperative hypoxemia or other complications may be attributable to the uncorrected PFO.




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S. A. Hart and R. A. Krasuski
Incidence of Asymptomatic Patent Foramen Ovale According to Age
Ann Intern Med, March 17, 2009; 150(6): 431 - 432.
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Anesth. Analg., March 1, 2008; 106(3): 769 - 770.
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F. A. Flachskampf
CON: The Incidental Finding of a Patent Foramen Ovale During Cardiac Surgery: Should It Always Be Repaired?
Anesth. Analg., September 1, 2007; 105(3): 613 - 614.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.