With the increased use of routine intraoperative transesophageal echocardiography (TEE), cardiac anesthesiologists often discover a patent foramen ovale (PFO) in the operating room. Whether or not to repair the defect surgically is a difficult question to answer because this may involve altering surgical management (eg, converting from an off-pump technique to on-pump technique) and, thus, perhaps increasing surgical risk. Furthermore, noninvasive techniques (percutaneous closure in the catheterization suite) are available for closure as well. Lastly, depending on the physiologic effects and/or symptomatology, closure may not even be indicated clinically. This complex scenario is further complicated by the fact that the patient is unable to contemplate the risks and benefits of available options because he/she is under general anesthesia.
S. Misra, Dash, P. Kumar, Koshy, T., Dr. Praveen Varma, Pal, S., Dineshkumar, U. Shanmukhas, Banayan, J., and Capdeville, M., “CASE 5--2012: incidentally detected patent foramen ovale in a patient undergoing aortic valve replacement: to close or not to close?”, J Cardiothorac Vasc Anesth, vol. 26, no. 4, pp. 721-728, 2012.