Patent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis

Rais, Gael; Vassallo, Paola; Schorer, Raoul; Pinto, Bernardo Bollen; Putzu, Alessandro

doi:10.1016/j.bja.2022.06.036

Cited by 3 publications

(3 citation statements)

References 45 publications

(79 reference statements)

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“…PFO is also associated with a significant increase in stroke risk during major noncardiac surgery [3,[18][19][20][21]. In a recent large retrospective cohort study that included 182,393 adults who underwent non-cardiac surgery, preoperatively diagnosed PFO was significantly associated with an increased risk of ischemic stroke within 30 days after surgery (3.2% vs. 0.5%) [4].…”

Section: Discussionmentioning

confidence: 99%

“…PFO is also associated with a significant increased risk of stroke in non-cardiac surgery due to right-to-left shunt (RLS) related to intraoperative hemodynamic alterations, leading to paradoxical embolism. Major surgery exposes patients with PFO to various factors that can cause RLS, including positive pressure mechanical ventilation, a severe reduction in systemic vascular resistance, clamping of great vessels, fluid therapy, anesthetic drugs, and patient positioning [3,4]. In addition to neurological complications, PFO can also cause hypoxemia and platypnea-orthodeoxia syndrome due to right-to-left shunting of deoxygenated blood [5].…”

Section: Introductionmentioning

confidence: 99%

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Transcranial Doppler Ultrasound and Transesophageal Echocardiography for Intraoperative Diagnosis and Monitoring of Patent Foramen Ovale in Non-Cardiac Surgery

Bianchini,

Vitale,

Romano

et al. 2024

Applied Sciences

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Background: perioperative stroke is one of the major complications after surgery. Patent foramen ovale (PFO) increases the risk of stroke in non-cardiac surgery by right-to-left shunt related to intraoperative hemodynamic alterations, leading to paradoxical embolism. Transesophageal echocardiography is the best tool for obtaining anatomical confirmation of PFO and essential details such as the PFO measure and the degree and direction of the shunt. Despite this, preoperative PFO screening is not routinely performed. Methods and results: we described the features of ten consecutive patients undergoing major abdominal surgery at the Abdominal Organ Transplant Intensive Care Unit, IRCCS Sant’Orsola, Bologna, Italy, who were screened for PFO using a PFO diagnostic and monitoring standardized intraoperative protocol by transesophageal echocardiography and transcranial color Doppler ultrasound. Finally, we highlighted the neurological and respiratory outcomes, the course and the management of three patients with intracardiac and extracardiac shunts. Conclusions: identifying an unknown PFO by a TCCD-TEE approach allowed the intraoperative monitoring of the shunt direction. It prevents the risk of complications secondary to paradoxical embolism in non-cardiac high-embolic-risk surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcranial Doppler Ultrasound and Transesophageal Echocardiography for Intraoperative Diagnosis and Monitoring of Patent Foramen Ovale in Non-Cardiac Surgery

Bianchini,

Vitale,

Romano

et al. 2024

Applied Sciences

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“…It is usually associated with a small amount of left-to-right shunt and asymptomatic. However, PFO is associated with a significant increase in the odds of stroke in non-cardiac surgery settings [ 29 ]. An increase in right atrial pressure (such as in the Valsalva maneuver) favours the reversal of the right-to-left shunt.…”

Section: Discussionmentioning

confidence: 99%

Using Transesophageal Echocardiography in Liver Transplantation with Veno-Venous Bypass Is a Tool with Many Applications: A Case Series from an Italian Transplant Center

Bianchini

Laici

Bordini

et al. 2023

JCDD

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Background: Hemodynamic instability (HDI) is common during liver transplantation (LT); veno-venous bypass (VVB) is a tool used in selected cases to ensure hemodynamic stability and for surgical needs. Transesophageal echocardiography (TEE) allows the transplant team to identify the causes of HDI and to guide therapies. We present a case series of four patients showing the valuable role of TEE during LT in VVB. Methods: We report four explicative cases of TEE use in LT with VVB performed at IRCCS Azienda Ospedaliero–Universitaria di Bologna. Four transplants were performed between 2016 and 2022. Results: Many authors have highlighted the diagnostic value of TEE during LT in the case of HDI. However, its specific role during LT with VVB is poorly described. This paper illustrates multiple potential uses of TEE in LT with VVB: TEE as a guide for catheterization and optimal cannula positioning, TEE as a tool for intraoperative Patent Foramen Ovale management, TEE as help for anticoagulation therapy and finally, TEE as support when evaluating bypass efficiency and correcting hypovolemia. Conclusion: TEE is a useful instrument during LT with VVB. However, further studies are needed to assess the suitable applications of TEE during LT in patients with HDI requiring VVB. TEE should be part of the anesthetist’s cultural background.

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Cerebrovascular disease in surgical patients

Grant

2024

Perioperative Care and Operating Room Management

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Patent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis

Cited by 3 publications

References 45 publications

Transcranial Doppler Ultrasound and Transesophageal Echocardiography for Intraoperative Diagnosis and Monitoring of Patent Foramen Ovale in Non-Cardiac Surgery

Transcranial Doppler Ultrasound and Transesophageal Echocardiography for Intraoperative Diagnosis and Monitoring of Patent Foramen Ovale in Non-Cardiac Surgery

Using Transesophageal Echocardiography in Liver Transplantation with Veno-Venous Bypass Is a Tool with Many Applications: A Case Series from an Italian Transplant Center

Cerebrovascular disease in surgical patients

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