BACKGROUND: The foramen ovale remains patent in about 25% of the population. Paradoxical embolism through a patent foramen ovale (PFO) may produce ischemic events. The closure of a PFO may prevent recurrence of cerebrovascular events. Percutaneous closure of a PFO is now-a-days a standard procedure and it appears to carry a low rate of complications. A surgical approach, in some cases, may be needed. METHODS: A patient underwent percutaneous closure of PFO. There was a residual shunt after the procedure and a fistula between the aortic root-to-right atrium was subsequently discovered. Surgery was carried out using a "Port-Access technique" through a right anterior minithoracotomy. RESULTS: Postoperative course was uneventful. Complete obliteration of the fistula was achieved. CONCLUSION: Minimally invasive surgery may be effective to treat PFO or even complications after previous percutaneous attempts of closure. An aesthetically acceptable conclusion, especially in young female patients, and a very low rate of morbidity may be accomplished.
BACKGROUND: The foramen ovale remains patent in about 25% of the population. Paradoxical embolism through a patent foramen ovale (PFO) may produce ischemic events. The closure of a PFO may prevent recurrence of cerebrovascular events. Percutaneous closure of a PFO is now-a-days a standard procedure and it appears to carry a low rate of complications. A surgical approach, in some cases, may be needed. METHODS: A patient underwent percutaneous closure of PFO. There was a residual shunt after the procedure and a fistula between the aortic root-to-right atrium was subsequently discovered. Surgery was carried out using a "Port-Access technique" through a right anterior minithoracotomy. RESULTS: Postoperative course was uneventful. Complete obliteration of the fistula was achieved. CONCLUSION: Minimally invasive surgery may be effective to treat PFO or even complications after previous percutaneous attempts of closure. An aesthetically acceptable conclusion, especially in young female patients, and a very low rate of morbidity may be accomplished.