title: Minimal access closure of patent foramen ovale: is it also recommended for patients with paradoxical emboli?
abstract: BACKGROUND
  To investigate the outcome of the port-access approach for patent foramen ovale (PFO) closure and to identify the long-term risk of recurrent thromboembolic events in the paradoxical embolus subgroup after closure.
  
  
  METHODS
  Between 1997 and 2001, 31 patients underwent PFO closure using the port-access approach. Twelve of the 31 patients underwent PFO closure secondary to at least one paradoxical embolic event leading to either transient ischemic attack or cerebral infarction. All patients were followed longitudinally with office visits and telephone interviews.
  
  
  RESULTS
  The mean age was 47 years (range 18 to 85 years). All procedures were completed successfully without conversion to median sternotomy. The mean duration of aortic occlusion and cardiopulmonary bypass for all patients (n = 31) was 32 minutes (range 17 to 55 minutes) and 72 minutes (range 40 to 124 minutes), respectively. Postoperative complications included pneumonia/pulmonary embolus (n = 1), transient atrial fibrillation (n = 3, 9.7%), and exploration for bleeding (n = 3, 9.7%). No deaths were recorded. All patients were assessed using transesophageal echocardiography, and the closure of the PFO was documented. The average length of hospital stay was 3.8 days (range 2 to 10 days) for patients with paradoxical emboli. The mean follow-up period for the paradoxical embolus subgroup was 23 months (range 4 to 45 months). One patient was lost to follow-up. Neither transient ischemic attack nor cerebral infarction recurred during follow-up.
  
  
  CONCLUSIONS
  The port-access approach to PFO closure is a safe and effective procedure, with acceptable initial experience outcome and excellent low-risk rate of recurrent thromboembolic events.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA.
authors.forename: Ramzi K
authors.initials: RK
authors.lastname: Deeik
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Thomas
authors.forename: Pranya
authors.initials: P
authors.lastname: Sakiyalak
authors.forename: Sally
authors.initials: S
authors.lastname: Botkin
authors.forename: Bradford
authors.initials: B
authors.lastname: Blakeman
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Bakhos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000209:etiology; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000150:complications*; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D013906:Thoracoscopy; D013923:Thromboembolism / Q000517:prevention & control