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Updated: Feb 1, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Interatrial Shunting Through an Asymptomatic Patent Foramen Ovale in Thoracic Surgery
Lucio Cagini1, Gabriela Cardaioli2, Marco Andolfi3
1Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy.
Background:
Patent foramen ovale (PFO) is present in as many as 25% of the general population and is considered an irrelevant condition in healthy subjects. Here, we sought to determine an association between an asymptomatic PFO at baseline and postoperative short-term adverse events in patients undergoing major pulmonary resection for lung cancer. In addition, we evaluated for the rate of PFO after pulmonary resections.
Methods:
This prospective, observational study assessed patients by transcranial Doppler with contrast at baseline and discharge. To confirm interatrial shunting, patients with positive transcranial Doppler at baseline also underwent contrast transthoracic echocardiography. Multivariate logistic regression models were adopted to investigate for independent factors that could have been associated with complications. Backward stepwise procedure was used for model selection.
Results:
Median age was 67.7 ± 9.2 years (range, 36 to 86), and 67% were men. Overall, 18 patients underwent pneumonectomy, 11 bilobectomy, and 118 lobectomy; 54% underwent right-sided procedure and 46%, left-sided. One perioperative death was recorded, and 34 patients had one or more cardiopulmonary complications. At baseline, PFO was positive in 25% (37 of 147) and negative in 75% (110 of 147); of the latter, 11% were positive at discharge. Detection of PFO at baseline, on multivariate analysis, was significantly associated with a risk of postoperative complications (odds ratio 2.5; 95% confidence interval: 1.1 to 5.8). Specifically, we observed a significant association between atrial fibrillation and positive PFO at baseline (odds ratio 3.5; 95% confidence interval: 1.4 to 9.0).
Conclusions:
Preoperative asymptomatic PFO was independently associated with postoperative adverse events. Moreover, 11% of patients who had negative transcranial Doppler studies at baseline had asymptomatic PFOs at discharge. Larger prospective studies are needed to further investigate for a prognostic impact of PFO in thoracic surgery.
Insights
Asymptomatic patent foramen ovale (PFO) significantly increases the risk of postoperative complications in lung cancer patients undergoing pulmonary resection. Early detection of PFO is crucial for managing potential adverse events.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pulmonary Medicine
Background:
- Patent foramen ovale (PFO) is common, often asymptomatic, and typically considered benign in healthy individuals.
- The clinical significance of a PFO in the context of major thoracic surgery remains under investigation.
- This study examines the association between baseline PFO and short-term adverse events following lung cancer resection.
Purpose of the Study:
- To determine if an asymptomatic PFO at baseline is linked to postoperative adverse events in patients undergoing major pulmonary resection for lung cancer.
- To evaluate the incidence of PFO detection after pulmonary resection procedures.
Main Methods:
- Prospective, observational study involving 147 patients undergoing major pulmonary resection.
- Transcranial Doppler with contrast used at baseline and discharge to detect PFO.
- Contrast transthoracic echocardiography employed for confirmation of interatrial shunting.
- Multivariate logistic regression analyzed factors associated with complications.
Main Results:
- 25% of patients had a positive PFO at baseline; 11% of initially negative patients showed PFO at discharge.
- A positive PFO at baseline was independently associated with an increased risk of postoperative complications (OR 2.5).
- A significant association was found between atrial fibrillation and a positive PFO at baseline (OR 3.5).
Conclusions:
- Preoperative asymptomatic PFO is an independent risk factor for adverse events after pulmonary resection.
- A notable percentage of patients develop PFO post-procedure, warranting further investigation.
- Larger studies are necessary to fully elucidate the prognostic impact of PFO in thoracic surgery.
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