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Pitfalls of undetected patent foramen ovale in off-pump cases
1Department of Cardiothoracic Surgery, Buffalo General Hospital, State University of New York at Buffalo, USA.
The Annals of Thoracic Surgery
|April 10, 1999
Insights
Undetected patent foramen ovale can cause severe desaturation during off-bypass heart surgery. Prompt cardiopulmonary bypass is needed to close the defect and complete the coronary revascularization procedure safely.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Cardiac Physiology
Background:
- Off-bypass coronary revascularization offers potential benefits but carries specific risks.
- Undetected cardiac anomalies can complicate surgical procedures.
Observation:
- Cardiac manipulation during off-bypass surgery led to a right-to-left shunt.
- This shunt caused severe and rapid patient desaturation.
Findings:
- A previously undiagnosed patent foramen ovale was identified as the cause of the shunt.
- Cardiopulmonary bypass was necessary to manage the desaturation and close the patent foramen ovale.
Implications:
- Highlights the importance of screening for patent foramen ovale before off-bypass cardiac procedures.
- Emphasizes the need for preparedness to manage intraoperative complications like shunts.
- Suggests potential modifications to surgical protocols for off-bypass revascularization.
Abstract:
We describe pitfalls of a hitherto undetected patent foramen ovale during the conduct of an off-bypass coronary revascularization. Manipulation of the heart resulted in right-to-left shunt and severe desaturation requiring institution of cardiopulmonary bypass to close the patent foramen ovale and complete the revascularization.