Patent foramen ovale closure prior to surgery in the sitting position

Abstract

Previously, patent foramen ovale (PFO) was an absolute contraindication to surgery in the sitting position. We report two patients with PFO who underwent surgery in the sitting position after percutaneous PFO closure. To our knowledge this is the first report of this technique.

Carbon dioxide field flooding reduces the hemodynamic effects of venous air embolism occurring in the sitting position

“…The cases were compared with a homogeneous control group of ten patients operated in the sitting position in 2011 for posterior fossa tumors, with standard setting environment. Patients of both the study group and the control group underwent echocardiography before surgery to detect any foramen ovale defect [24]. The exam was positive only in two patients of the control group (a meningioma of the foramen magnum and a ponto-cerebellar schwannoma), and in one case of the study group, a 17-yearold female with a pineal pilocytic astrocytoma.…”

Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges

“…TOE, transcranial doppler or end tidal CO 2 monitoring can be used to detect clinically significant venous air emboli [ 81 , 82 ]. However, such monitoring cannot prevent air embolism, and few studies have proposed preoperative PFO closure [ 83 , 84 ]. However, there are no published clinical studies, and timing of surgery post-intervention or duration of antiplatelet therapy remains unanswered.…”

European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

“…Since perioperative monitoring can make a timely diagnosis but cannot stop ongoing embolism, preoperative PFO closure has been proposed and presented in extremely limited preliminary reports with good results for the ensuing neurosurgical operation in the sitting position 93,121,122 .…”