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Patent foramen Ovale-related paradoxical embolism after noncardiac surgery

Published:November 29, 2022DOI:https://doi.org/10.1016/j.jccase.2022.11.001

      Abstract

      Patent foramen ovale (PFO) is a remnant of the fetal circulation that remains in a significant portion of the adult population, predisposing to a higher risk of stroke. This risk is further elevated in the postoperative hypercoagulative period. Here we present a case where a patient underwent a total knee arthroplasty and presented with right-sided hemiparesis on post-operative day 2. Subsequently, the patient underwent percutaneous PFO closure with a 25-mm Amplatzer PFO Occluder (Abbott; Chicago, IL, USA). The patient has not had a stroke since the PFO closure. Recent randomized trials have demonstrated superiority of percutaneous PFO closure over standard-of-care medical therapy for secondary prevention of PFO-associated stroke. Since post-operative PFO-associated stroke is under-recognized in clinical practice, further large-cohort studies are needed to evaluate whether PFO screening and device closure would decrease post-operative stroke risk for noncardiac surgeries.

      Learning Objective

      Patent foramen ovale (PFO) is a remnant of the fetal circulation commonly found in the adult population, which can increase the risk of stroke. Stroke is a complication of PFO, yet closure of this remnant only occurs on a specific case-by-case basis. Further research in this area is required to determine whether a larger population would benefit from PFO closure.

      Keywords

      Abbreviations:

      PFO (Patent Foramen Ovale), CHD (Congenital Heart Defect), CI (Confidence Interval), NIHSS (US National Institutes of Health Stroke Scale), RA (Right atrium), RV (Right ventricle), LA (Left atrium), LV (Left ventricle)
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