Echocardiographic guided, transatrial closure of a patent foramen ovale
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(2020) 15:255
RESEARCH ARTICLE
Open Access
Echocardiographic guided, transatrial closure of a patent foramen ovale Felix Fleissner1* , Paul Frank2, Axel Haverich1 and Issam Ismail1
Abstract Background: The management of an incidental patent foramen ovale found during planned cardiac surgery remains a challenge, and current guidelines are not helpful. Although evidence is accumulating, that closure of an incidental found patent foramen ovale might be beneficial, especially in planned off-pump procedures, the diagnosis of a formerly unknown patent foramen ovale with the patient on the operation table has vast consequences by making it necessary to switch to on pump, bi-caval cannulation for patent foramen ovale closure. We therefore developed a technique for transatrial closure of a patent foramen ovale, guided by transesophageal echocardiography. Results: We have performed this surgery in 9 patients. None of them had a previously diagnosed patent foramen ovale. Mean age was 74 (±5) years, Operation time was 175 min (± 34 min), Clamp time 35 min (± 16 min) and Cardiopulmonary bypass time 80 (±17 min). Mortality was 0%. Periprocedural transesophageal echocardiography revealed closure of the patent foramen ovale in all cases. Conclusion: We report a new surgical method for transoesophageal echocardiography controlled closure of a patent foramen ovale without the need for an atriotomy. This new technique is especially useful for the closure of patent foramen ovale in the setting of on-pump and off-pump coronary artery bypass graft surgeries alike. Keywords: Patent foramen ovale, PFO, Off-pump-surgery, OPCAB, CABG, Valve surgery
Introduction The patent foramen ovale (PFO) is present in approximately 27% of the general population [1]. With the widespread use of transesophageal echocardiography (TEE) during cardiac surgery, more PFO are diagnosed intraoperatively [2]. There are so far no general recommendations, on how to treat a PFO diagnosed intraoperatively. The traditional surgical technique would be to perform a direct closure via an atriotomy. This, of course, makes on pump surgery and double venous cannulation mandatory. Leaving the PFO intact however, might expose the patient to unclear immediate and long-term risks (eg, hypoxemia and paradoxical embolism such as stroke). So far, according to a survey
among cardiac surgeons in the United States, only approximately 28% of surgeons always close a PFO during cardiac surgery, even if off-pump-surgery was initially planned [3]. This low rate of closure of an incidentally found PFO during cardiac surgery is most likely explained by the fact, that the “classical” approach to PFO closure involves cardiopulmonary bypass with bicaval cannulation and is therefore a major change in the planned procedure. Hence, we developed an easy surgical method for TEE guided closure of a PFO transatrially without the need for an atriotomy or double venous cannulation. This new technique can be performed as well on and off pump, making it a feasible approach for eligible patients.
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