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Incidental PFO closure

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DrN2O

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The thread on TEE use brought up the topic of incidental PFO found during cardiac surgery. Our policy is to close all of them. Now I agree with closure if there is any concern of perioperative hypoxemia in patients with failing RV or pulmonary hypertension. The risk of stroke is always used for its closure. What do you think? And what about this JAMA article:

JAMA. 2009 Jul 15;302(3):290-7. doi: 10.1001/jama.2009.1012.
Prevalence and repair of intraoperatively diagnosed patent foramen ovale and association with perioperative outcomes and long-term survival.
Krasuski RA, Hart SA, Allen D, Qureshi A, Pettersson G, Houghtaling PL, Batizy LH, Blackstone E.

http://www.ncbi.nlm.nih.gov/pubmed/19602688
 

TrustMe

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People getting all excited about PFO's always bugs me. Think of everything that has to happen at the exact same time to get a clot across there.

1. Must have large enough PFO
2. Must have clot somewhere in venous circulation
3. Must have physiologic event that causes right sided pressures to be elevated above left sided pressures enough to get right-to-left flow (i.e. coughing, pooping, squatting 650 lbs(JPP), etc.)
4. Must have all of these things happend at exactly the same time

I'm no actuarial genius, but this is probably a fairly uncommon occurance.
 

seinfeld

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I dont recommend to surgeons closure unless

1. Hx of TIAs (multiple) of unknown source
2. Repairing Mitral/ tricuspid and Its a large defect (if you're already there then just throw a stitch mentality)

Overall i feel it could decrease risk of paradoxical emboli but increase risk of LA clot formation.
 
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